When the Attending goes into rapid fire pimp mode
And you get them ALL RIGHT!
Over the last four years, I’ve started a small collection of questions that I repeatedly gotten pimped on by various attendings from many different services. We at QuickHits decided to empower the med student by starting a weekly post with a number of high yield questions along with some you-know-it-or-you-don’t type questions that you can impress some attendings with.
We hope this allows our readers to continue to build a thorough knowledge base. Give a shot at the first volume of pimp notes.
See how many you get right. Leave some comments!:
- Highly sensitive physical exam test for mandibular trauma/fracture?
- ST Segment elevation in right sided V4 lead is high suggestive of?
- Most severe complication (and most common cause of death) in ITP?
- Metabolic causes of acute confusion?
- Pneumonia classically associated w/ bullous myringitis?
26 year old male presents with his elbows, wrist, and fingers locked in flexion. He started having an exacerbation of his anxiety attacks about 4 hours ago. When seen in the ED, he is hyperventilating and complaining of tingling in his fingers and inability to relax his hands.
CONTINUE READING FOR ANSWERS
Highly sensitive physical exam test for mandibular trauma/fracture
- Tongue blade test (sensitivity of 95.7%; a specificity of 63.5%)
- Acedemic Life in Medicine Blog post on Tongue blade test
- source: Robert A, Schwab MD et al. Clinical predictors of Mandibular Fractures. Am J Emerg Med 1998;16:304-5.
ST Segment elevation in right sided V4 lead is high suggestive of: Right ventricular ischemia/infarction
Most severe complication in ITP: intracerebral hemorrhage
Metabolic causes of acute confusion: hypoglycemia, hypo/hypernatremia, hypercalcemia
Pneumonia classically associated w/ bullous myringitis: Mycoplasma pneumoniae
- common cause of pneumonia in young adults. It is classically associated with bullous myringitis.
Diagnosis of X-ray: Kienbock disease
- Avascular necrosis of the lunate
- typically seen dominant hand of male 20-40
- Radiopedia link of Kienbock’s
- Diagnoisis: tetany 2/2 hyperventilation
- Pathophys: hyperventilation –> decreased levels of CO2 –> increased in pH –> increased albumin binding to calcium –> hypocalcemia –> constriction of blood vessels and tingling
- Treatment = Treat underlying cause –> stop hyperventilation/anxiety attack, put on rebreather mask to increase CO2
- Neurologic bulletin from UMass w/ case study and brief literature review