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CRACKCast & Physicians as Humans on CanadiEM

CRACKCast (Core Rosen's and Clinical Knowledge) helps residents to "Turn on their learn on" through podcasts that assist with exam prep by covering essential core content. Physicians as Humans explores the struggles that physicians face and how they have overcome them. From addictions, mental health issues, and all manner of personal crises will be discussed to help let those who are currently struggling know that they are not alone. CanadiEM aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources.
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CRACKCast & Physicians as Humans on CanadiEM
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Now displaying: Category: crackcast
Jun 26, 2017

This episode covers Chapter 87 of Rosen’s Emergency Medicine

 

  1. What is an atheroma and how is it formed?
  2. What are the classic symptoms of arterial insufficiency?
  3. Provide a differential diagnosis for chronic arterial insufficiency.
  4. What is blue toe syndrome? What is its significance?
  5. Differentiate between thrombotic and embolic limb ischemia based on clinical features
  6. What is the management of an acutely ischemic limb?
  7. List three disorders characterized by abnormal vasomotor response.
  8. Describe Raynaud's disease and how it’s treated?
  9. What is the most common site for arterial aneurysm in the leg?
  10. List four potential sites for upper extremity aneurysms, and their associated underlying causes.
  11. Name three types of visceral aneurysms and their associated conditions.
  12. List 6 ddx of occluded indwelling catheter + describe the management of suspected line infection.
  13. What are the two types of AV fistulas used for dialysis?
  14. How do you access an AV fistula?
  15. List 5 complications of dialysis fistulas + treatment
  16. List the 3 types of thoracic outlet syndrome. What are the typical symptoms of thoracic outlet syndrome? What is a simple bedside test for this condition?
  17. List 4 anatomic abnormalities associated with thoracic outlet syndrome.


    Wisecracks:

    Describe Buerger’s sign and ankle brachial index
    List clinical criteria for Buerger’s Disease (5)
    What is Leriche's syndrome?
    List 4 types of infective aneurysms
    Differentiate between arterial insufficiency ulcers and venous stasis ulcers
Jun 15, 2017

This episode covers Chapter 86 of Rosen’s Emergency Medicine. AAAs are our Great-White-Buffalo in emergency medicine. You need to know this!

 

  1.  List six presentations of an abdominal aortic aneurysm.
  2. Compare Aneurysm and Pseudoaneurysm
  3. List common misdiagnoses in patients with ruptured AAA
  4. List three common early and delayed complications of AAA repair
  5. List common delayed complications of Endovascular repair

 

 

Wisecracks:

 

  • What to do about the intact, asymptomatic aneurysm?

 

 

Jun 8, 2017

This episode covers chapter 84 of Rosen's Emergency Medicine. All the little nuggets of medical goodness you wanted to know about hypertension related emergencies.

  1. Define the three classes of hypertension relevant to emergency medicine practice
  2. List 10 possible etiologies for hypertension.
  3. What is the pathophysiology of target-organ damage?
  4. How does hypertensive encephalopathy occur?
  5. List 6 hypertensive emergencies; their management goals; the optimal agents for BP control and any relevant caveats
  6. List five intravenous antihypertensive medications and their mechanism of action.
  7. Describe the ER management of poorly controlled HTN

Wisecracks:

  1. What are the management targets / indications for treatment in the following pts:
    1. 57 yo male with ICH and no signs of ↑ ICP.
    2. 39 yo female with SAH in the ED.
    3. 22 yo female with eclampsia.
    4. 66 yo female with ACS.
    5. 57 yo male with aortic dissection.
    6. 62 yo female with ICH, ↓ GCS, shift on CT scan.

 

Jun 5, 2017

This episode covers Chapter 83 of Rosen's Emergency Medicine.

 

  1. List 6 RFs for bacterial endocarditis
  2. List 5 common bacteria responsible for infective endocarditis
  3. Give three examples of immunologic sequelae of IE.
  4. Give three examples of vascular sequelae of IE.
  5. What are the diagnostic criteria for endocarditis, and how are they used?
  6. List 5 lab or investigative findings in bacterial endocarditis
  7. Describe the treatment of infective endocarditis
  8. List four complications of IE.
  9. List the indications for infectious endocarditis prophylaxis. What are the empiric antibiotics used for pts with suspected infectious endocarditis?
  10. Describe the Jones Criteria for Acute Rheumatic Fever
  11. What is the treatment of rheumatic fever
  12. Name three causes of acute mitral regurgitation.
  13. How is acute MR managed?
  14. What is the pathophysiology of mitral valve prolapse?  How does it present?
  15. List four causes of mitral stenosis.
  16. List four causes of aortic valve insufficiency.
  17. List 3 physical exam findings associated with AS
  18. What is critical aortic stenosis?Outline the ED management for a pt with critical aortic stenosis with CHF and hypotension.
  19. List 5 complications of prosthetic valves. 

WiseCracks:

  1. Describe
    1. Janeway lesions
    2. Osler nodes
    3. Splinter hemorrhages
    4. Roth Spots
  1. What are the HACEK organisms, and what is their significance in pts with IE?
  1. Brief run down of all valvular disease - in one or two lines.
Jun 1, 2017

This episode covers chapter 82 of Rosen's Emergency Medicine. Take a listen for all those juicy pericardial-pump-pearls!

 

  1. List eight causes of pericarditis.
  2. Describe typical pain of pericarditis, expected lab work abnormalities,
  3. What is the typical sequence of ECG changes in pts with pericarditis? (the stages)
  4. Describe the treatment of pericarditis associated with: Uremia, Neoplasm, and SLE
  5. Outline the management of Dressler's syndrome.
  6. What is the pathophysiology of cardiac tamponade? Describe the mechanism of hypotension in pericardial tamponade and list 4 expected findings on physical examination.
  7. Describe the procedural steps in pericardiocentesis
  8. List 4 causes of pneumopericardium and one specific PEX finding
  9. List five causes of constrictive pericarditis.
  10. What is the pathophysiology of purulent pericarditis?  List 5 organisms responsible for infectious pericarditis? How is it managed?
  11. Describe the pathophysiology of hypertrophic cardiomyopathy
  12. Describe the clinical exam and ECG findings associated with HCM
  13. List 5 RFs for sudden death in HCM
  14. A pt with known hypertrophic cardiomyopathy presents to the ED with acute cardiogenic pulmonary edema causing mild hypoxia.  What is the general approach to management in the ED?  Explain your choices.
  15. List four causes of dilated cardiomyopathy.
  16. Describe ECG findings of dilated cardiomyopathy
  17. List 5 RFs for developing a dilated cardiomyopathy
  18. In what time frame would one expect peripartum DCM?
  19. List 5 causes of restrictive cardiomyopathy
  20. List 8 common pathogens responsible for myocarditis, and 3 non-infectious causes of myocarditis
  21. Describe the stages of viral myocarditis and the management at each stage

 

 

Wisecracks:

 

  1. What are some functions of the pericardium?
  2. What are Chagas Disease and Trichinosis, list bizz-buzz features for each?
  3. What are the expected cardiac findings in Lyme disease and how is it treated?
  4. How does sarcoid affect the heart?
  5. Amyloidosis?

 

May 29, 2017

This episode covers Chapter 81 of Rosen’s Emergency Medicine. This one is mint! Heart failure is one of those must-know-about presentations, you WILL see this in the ED.

 

  1. Define
    1. Cardiac index
    2. Preload
    3. Afterload
  2. Describe:
    1. How compliance changes the relationship between end diastolic pressures and volume
    2. the Frank-Starling relationship
    3. Pousseils Law and LaPlaces Law
  3. List 3 CV and 4 Neurohormonal physiologic compensatory mechanisms in CHF
  4. List the 5 most common disease processes resulting in HF and briefly describe the contribution of each
  5. Describe the different classifications of heart failure:
    1. Acute vs. Chronic HF
    2. Systolic vs. Diastolic dysfunction
    3. Right vs. Left sided HF
    4. High-output vs. Low-output HF
  6. Describe the NYHA function HF Classes and the Killip Classification
  7. List 10 common precipitants of acute HF
  8. List 6 historical predictors of acute HF and 6 clinical features of acute HF
  9. List 5 CXR and 5 ECG findings of HF
  10. What is the role of BNP in HF?
  11. Describe the primary management goals in acute HF
  12. Describe the mechanism of action of NIPPV in HF. Who needs to be intubated? When is it contraindicated?
  13. Describe the pharmacologic treatment strategy for:
    1. Acute pulmonary edema + adequate perfusion
    2. Acute pulmonary edema + hypotension
  14. How do nitrates work in acute pulmonary edema? What is the dose?
  15. List 10 treatment options for chronic HF
May 25, 2017

This episode covers chapter 80 of Rosen's Emergency Medicine. All those juicy pearls about those funny little [black] boxes in your patients chest.

 

Chapter 80 – Implantable Cardiac Devices

 

  1. List 5 Indications for permanent pacing
    1. What are common Pacemaker types?
  2. Pacemaker nomenclature - what do the 5 letters mean
  3. List the causes of pacemaker malfunction (main categories with 2 examples each)
  4. List the complications of a pacemaker insertion
  5. What is pacemaker pseudo-malfunction?
  6. What is pacemaker syndrome, which type of pacer is most commonly involved, and what is the tx?
  7. What does magnet application do to a pacemaker? to an ICD?
  8. Indications for ICD
  9. Causes of shock delivery in patient with ICD
  10. Causes of syncope/presyncope in patient with ICD
  11. Fxns of an ICD

 

Wise Cracks

 

  1. What do you see on ECG when pacer battery dies (2)?
  2. What is twiddler’s syndrome?
  3. Describe your Approach to LVAD complications
  4. Approach to Pacemakers
May 23, 2017

This episode covers Chapter 79 of Rosen’s Emergency Medicine.

All those funny squigly marks on the ECG confusing you? Us too. Here is some knowledge to help you out.

  1. What is the blood supply of the following parts of the conduction system: SA node, AV node
  2. What are the three pathophysiologic mechanisms for dysrhythmias?
  3. What causes & how does AV nodal reentry tachycardia occur?
  4. List the classes of antidysrhythmics. Describe their mechanism of action and usual uses, as well as an example of each.
  5. How does digoxin work as an antidysrhythmic? When is it used?
  6. List underlying etiologies of sick sinus syndrome.
  7. What are three ECG presentations of sick sinus syndrome?
  8. Define 1° heart block.  List three causes.
  9. Differentiate between the two types of  2° heart block with respect to etiology, ECG appearance and management.
  10. What is ‘high grade’ heart block?  How is it managed?
  11. Describe the difference between AV dissociation & 3° AV block.
  12. Compare PAC’s to PVC’s.
  13. Give a differential diagnosis of irregularly irregular tachycardia.
  14. Define pre-excitation and list the 3 ECG features of classic WPW
  15. Explain the concept of antidromic and orthodromic conduction with respect to WPW. Which pts with WPW should not receive AV node blockers?  Why?
  16. List 10 causes of PVC and VT
  17. How do you differentiate b/n SVT with aberrant conduction & ventricular tachycardia?
  18. List 10 causes of atrial fibrillation.
  19. Describe the management of AFIB, including a discussion about the CHADS2 score and long term stroke risk.
  20. What is Brugada syndrome? What is the management?



WiseCracks:

 

  1. List 8 side effects of Amiodarone.
  2. Describe features that favor VT over SVT.
  3. Describe the Brugada approach to the Dx of VT
  4. List Causes of acquired pause-dependent QT prolongation causing Torsades & List causes of adrenergic dependent TdP
  5. Describe the treatment of pause dependent TdP
  6. Define PSVT and describe management
  7. What’s Ashman’s phenomenon?
May 18, 2017

Here is the follow-up to the mammoth ACS chapter. This one has some key factoids to put into your mind map / memory pallace / organic computer.

 

  1. List Sgarbossa criteria for AMI in pre-existing LBBB
  2. What is Takotsubo cardiomyopathy and how does it present?
  3. Describe the kinetics of cardiac biomarkers (Troponins and CK)
  4. List DDx for ↑ Troponin
  5. What is the utility of CTA in the diagnosis of MI?
  6. What is the role of ED-based chest pain centers?
  7. List 3 phases of delay in the management of AMI; and describe the time-points in ED management of AMI.
  8. What are door-to-needle and door-to-balloon timelines by AHA recommendations?
  9. Describe the mechanism of action and indications/contraindications for
    1. Nitroglycerin
    2. Morphine
    3. BBlockers
    4. ACE-I
    5. Antiplatelet Therapies
    6. Anti-thrombins
  10. Describe eligibility criteria for Fibrinolytics
  11. List contraindications to Fibrinolytic therapy in MI
  12. What is the utility of Rescue PCI and Facilitated PCI?
  13. List 5 indications for Rescue PCI
  14. Describe factors assisting with decision to utilize PCI or thrombolytics
  15. In NSTEMI, who will benefit from an early invasive strategy of management?

Wise Cracks:

 

  1. What is the HEART Score?
  2. What is the management of ACS in the setting of recent cocaine use?
  3. How is STEMI diagnosed in the setting of LBBB?
  4. How is STEMI diagnosed in the setting of a ventricular pacemaker?
  5. When should you be getting a 15 lead ECG?
May 16, 2017

This episode covers Chapter 78 of Rosen's Emergency Medicine. Acute Coronary Syndromes... its a gooder.

Acute Coronary Syndromes Part A (Monday)

  1. Define Stable Angina, UA, AMI
  2. Describe the pathophysiology of AMI
  3. What are the components of prehospital management of AMI
  4. List population RFs for CAD.
    1. Do they matter in the evaluation of a specific patient?
  5. List RFs for atypical presentation of ACS. What are the risks of atypical presentations?
  6. List 8 early complications of AMI and briefly describe the management of each one.
  7. Describe the progression of ECG changes in STEMI
  8. List expected ECG changes (ST↑ and reciprocal ST↓) and culprit vessel for the following:
    1. Anterior wall MI
    2. Lateral wall MI
    3. Inferior wall MI
    4. RV wall MI
    5. Posterior wall MI
  9. Describe the ECG characteristics of Left Main Occlusion
  10. What is Wellens’ sign and what is it’s significance
  11. List 10 DDx for ST-elevation
  12. Describe the ECG features of
    1. Benign early repolarization
    2. Pericarditis
    3. LBBB
    4. RBBB
    5. Ventricular-paced rhythm
    6. LVH / Strain-pattern
    7. LV aneurysm


Wise Cracks:

What are the STEMI equivalents? Know these patterns!!!

May 11, 2017

This episode covers Chapter 77 of Rosen’s Emergency Medicine. The Pleural Space is not to be trifled with!

  1. List 5 RFs for 1° spontaneous PTX.  
  2. What is the most common pathophysiologic cause of PTX?
  3. List 8 causes of 2° spontaneous PTX
  4. List 5 clinical findings suggestive of tension PTX
  5. Describe how to estimate the size of a PTX
  6. Describe the management of 1° and 2° spontaneous PTX
  7. Describe the procedure needle aspiration of a PTX. List 3 benefits of this over TT
  8. Describe the procedure of TT. List 6 complications of TT placement and contraindications.
  9. List 10 causes of pleural effusion.  What is the most common transudative and exudative?
  10. What is starling’s law and how does it apply to the development of pleural effusions
  11. List 5 CXR findings of pleural effusion
  12. Describe Light’s Criteria for pleural effusion and list 5 other tests to perform on pleural fluid. What does a low pH indicate?
  13. Describe the procedure of thoracentesis.  List 2 contraindications and 9 complications

 

Wise Cracks

  1. What is Catamenial pneumothorax? How is it tx?
  2. How do you properly Secure a chest tube?
  3. Describe the seldinger technique for chest tube insertion
  4. What are the false positives for PTX on lung U/S?
May 8, 2017

This episode covers Chapter 76 of Rosen’s Emergency Medicine. Have you ever seen pneumonia? Yeah.... we thought so. Now here are all the nitty-gritty details.

  1. What are the typical associative pathogens?

  2. Describe the typical clinical presentation/RFs/Management for each of the following

    -S. pneumonia
    -H. influenzae
    -Staph aureus
    -Klebsiella
    -Mycoplasma pneumoniae & Chlamydia pneumoniae
    -Legionella
    -Anaerobes
    -Pseudomonas
    -PJP & Other Fungal Pneumsonia
    -Tuberculosis
    -Tularemia
    -Hantavirus

  3. List the typical etiologies of viral pneumonia.

  4. Which patient groups should receive pneumovax?

  5. Which pneumonias can present with cavitating lesions (abscesses) on x-ray

  6. What is the differential for possible pneumonia visible on CXR?

  7. Describe the analysis of pleural fluid.
    -Which effusions should be sampled?
    -What are Light's criteria?

  8. What is the CURB65 score?

     

 

May 4, 2017

This episode covers Chapter 75 of Rosen’s Emergency Medicine.

 

1. List potential causes of pharyngitis. (List 5 viral and 5 bacterial etiology of pharyngitis)

2. What are the indications for steroids in a patient with pharyngitis?

3. List causes of epiglottitis.

4. What are the deep spaces of the neck? List 4 deep space infections of the neck

5. What are the typical bacterial causes of deep space infections? What are the different syndromes called?

6. What are the potential complications of deep space neck/face infections? List 5.

7. When do the sinuses typically develop?

8. What the pathophysiology of sinusitis? What are the typical pathogens?

9. Describe the management of acute rhinosinusitis and list 6 predisposing factors


Wisecracks:

List 5 suppurative and 5 non-suppurative complications of GABHS
List 4 findings on lateral neck xray of epiglottitis
Describe an approach to airway management in deep space neck infections
What are lateral neck xray findings suspicious for RPA?

May 1, 2017

This episode covers Chapter 74 of Rosen’s Emergency Medicine. As Vanilla is to chocolate, COPD is to Asthma. Look for all things wheez-e-y here.

  1. Define acute exacerbation
  2. Describe GOLD classification for COPD
  3. List factors of decompensation or triggers of an AECOPD
  4. Name 4 mimics for AECOPD
  5. What are the clinical features used to diagnose AECOPD?
  6. Describe the ED management of AECOPD.
  7. What does the end tidal tracing look like in COPD?
  8. List indications and contraindications to NIPPV in COPD
  9. Which patients with AECOPD should be treated with antibiotics?
  10. Which patients with AECOPD require admission?
  11. List indications for intubation for AECOPD

 

Wise Cracks

  1. List 4 CXR and 3 ECG findings in COPD

 

Apr 27, 2017

This episode covers Chapter 73 of Rosen’s Emergency Medicine. The ancient Greeks knew about Asthma... so should you! We give you all the major points for diagnosis and treatment in the ED.

 

Sign post

 

  1. 10 different causes of a wheeze.
  2. List 8 risk factors for death from asthma
  3. List 6 objective findings of severe asthma
  4. 10 therapies for an acute severe asthma exacerbation
  5. Discuss a ventilation strategy for the critically-ill asthmatic patient
  6. Discuss disposition and discharge planning for an acute asthma exacerbation presenting to the ER

 

Wise Cracks

  1. What is delayed sequence intubation? Can it be used for severe Asthma exacerbation?
  2. What about pregnancy and Asthma is so important?
Apr 24, 2017

This episode covers Chapter 72 of Rosen’s Emergency Medicine. All those pearls you need for ears, masses, nose bleeds and weird stones in weird places.

  1. Define Otitis Media
    1. Acute
    2. Chronic
    3. Recurrent
  2. Describe the diagnosis treatment of Otitis Media
  3. What are the complications of OM?
  4. Describe the diagnosis and tx of Otitis Externa
  5. Differentiate from malignant otitis externa
  6. What is Ramsay Hunt Syndrome? How is it Tx?
  7. Describe your approach to sudden hearing loss
    1. How is it treated?
  8. Name 10 causes of epistaxis
  9. Describe your approach to tx epistaxis
    1. Anterior bleeds
    2. Posterior bleeds
  10. What is the differential diagnosis of neck masses?
  11. What is SIALOLITHIASIS? How is it tx? 
Apr 20, 2017

This episode covers Chapter 71 of Rosen’s Emergency Medicine. For such a small organ, the eye has A LOT of things to cover. Here we finish up in everything you need to know about that juicy ball of potential badness.

  1. List 10 causes of ↓ vision post blunt eye trauma
  2. What historical features are concerning for intra-ocular foreign body?
  3. List 4 options for treatment of corneal abrasions
  4. Describe the management of traumatic hyphema
  5. What causes the finding of a ‘second pupil’ post-trauma?
  6. Describe the physical findings of globe rupture and describe management
  7. List 5 indications for ophtho consultation for eyelid lacerations
  8. Describe diagnosis and treatment for orbital floor fractures:
  9. List 2 findings on X-ray of orbital floor fracture
  10. List indications for surgical repair of orbital floor fracture
  11. Describe the clinical findings of retrobulbar hemorrhage and the steps in performing lateral canthotomy
  12. List 3 complications of ocular trauma
Apr 10, 2017

This episode covers Chapter 70 of Rosen’s Emergency Medicine.

 

  1. How are teeth traditionally numbered?
  2. Describe the classification and management of tooth fractures
  3. Describe the method for reducing a jaw dislocation? What is the usual direction of the dislocation?
  4. Explain Ludwig’s Angina and its management
  5. List 3 complications of maxillary (eg canine) tooth infection?
  6. Describe management of Dental Caries vs Periapical abscess
  7. Describe your approach to Acute Necrotising Ulcerative Gingivitis
    1. what is Vincent’s Angina?
    2. what is cancrum oris?
  8. Rapid Fire treatment for the following:
    1. Post root canal pain
    2. Cracked Tooth or Split root syndromes
    3. Maxillary Sinusitis
    4. Atypical Odontalgia
    5. Post extraction pain
    6. Neuropathic pain
    7. Temporomandibular Myofascial Pain Dysfunction Syndrome
    8. Pericoronitis
    9. Apthous Stomatitis


WiseCracks

  1. Spot diagnosis
Apr 3, 2017

This episode covers Chapter 69 of Rosen’s Emergency Medicine.

 

Sign Post:


1. List six types of elder abuse?
2. List ten risk factors for elder abuse?
3. List ten questions to screen for elder abuse?
4. What are some indicators on the medical history and physical exam that may suggest ongoing elder abuse?
5. Discuss ethical and legal implications of elder abuse. Who needs to be reported?

Mar 20, 2017

 

This episode covers Chapter 67 of Rosen’s Emergency Medicine. Its a heavy topic, but important to get right.

  • What precautions should be taken prior to engaging in potential sexual abuse cases?
  • What information can be useful in determining the location and likelihood of injury in sexual assault?
  • What is the prevalence of mental illness in sexual assault patients?  Which populations are found to have a higher proportion of mental illness?  What effect does mental illness have on the severity of the attack?
  • What factors make genital injury more likely to be observed?  Less likely?
  • What are the risks of STI's after sexual assault?
  • What are appropriate treatments for STI prophylaxis in cases of suspected sexual abuse/assault?
  • What resources exist to help medical providers and any victims of sexual abuse?
  • What differences should be considered with male victims of sexual assault?

 

------------------------------

Thank-you to Dr. Sampsel for her assistance with this episode!

Mar 6, 2017

This episode covers Chapter 65 of Rosen’s Emergency Medicine. Its a big intro into the next few chapters covering forensic medicine in the emergency department. Tighten up those boot straps, this stuff is heavy!

 

  1. What are some pearls and pitfalls for ER physicians when dealing with Forensic Emergency Medicine?  
  2. What are proper terms used to describe wound injury patterns?
  3. What’s the anatomy of a cartridge (bullet)? What are the types and important aspects of wound ballistics?
  4. What signs would you see for the various ranges of fire of a bullet?
  5. What are common red flags to alert you to the possibility of domestic violence? What risk factors make domestic violence more common?
  6. Describe the different types of blunt force pattern injuries and the pathophysiology of how they occur. Do the same for sharp force and thermal wounds.
  7. What does the Health Insurance Portability and Accountability Act permit a physician to disclose to the investigating law enforcement officer?
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