christopher lee, md, faaem associate professor department of emergency medicine stony brook...

Christopher Lee, MD, FAAEMChristopher Lee, MD, FAAEM

Associate ProfessorAssociate Professor

Department of Emergency MedicineDepartment of Emergency Medicine

Stony Brook University Medical CenterStony Brook University Medical Center

StimulusStimulus

Questions for BoardQuestions for Board

Bullet Points

• Acute Fever, Shaking Chills (Rigors), Rusty Colored Sputum-Pneumococcous

• Pneumonia after virus or IVDA-think Staph Aureus

• Pet shop owner, avian-think Chlamydia Psittaci

• Acute Fever, Current Jelly Sputum, Bulging fissure sign-Klebsiella

• NH, Hospitalized, Intubated patient with green sputum-Pseudomonas Aeuruginosa

• Cystic Fibrosis-Think Pseudomonas Serratia

• Eardrum showing bubbles-Think Bullous Myringitis

• Mycoplasma Pneumonia

• Butterfly pattern in CXR

• Cold agglutinin

• GBS

• Temp/Pulse Dissociation

• Fusobacterium Necrophorum

• Lemierre’s Syndrome

• IJV thrombophelebitis with pharyngitis

• PAM-Pan Amoebic Encephalitis

• Katrina Havasu

• Naegleria Fowleri

• Travel through nose to cribiform plate and forebrain

• Pott’s Puffy tumor-Brain Abscess

• Dacrocystitis-Staph

• Dendritic Corneal Ulcer-Hepes (Hutchingson’s sign)

• Parotitis in diabetic-think staph with sialolith and in children think mumps with orchitis

• Blue dot sign-Testicular appendigis torsion

• Potts Puffy Tumor-Brain Abscess

• Kerion-Tinea Capitis (systemic antifungal)

• Dacrocystitis-Staph aureus

• Parotitis-Diabetic adult: Staph aureus with concurrent sialolithe in the stenton’s and wharton’s duct. But in kids think viral infection Mump with orchitis

• Malignant OE-In diabetic think Pseudomonas

• Mucormycosis-fever and black discharge from sinusitis (Amphotericin B)

• Epidemic Keratoconjunctivis-Adenovirus(highly contagious, severe chemosis)

• Neonatal conjuctivitis- Day 3-5, think Gonorrhea and 5-14 Chlamydia, but treat for both

• Ruptured Globe-Teardrop shaped pupil, chemosis with seidel test

• Transplacental hemorrhage: 75% of pregnant patient have this but only 2-3 % at risk of isoimmunization in Rh- mother

• <12 week mini-dose of rhogam (50 mcg)

• >12 week-full dose of rhogam (300 mcg)

• Septic abortion: abortion with uterine infection with fever and uterine tenderness (1-2% of spontaneous ab)

• Methotrexate for Ectopic pregnancy-Non ruptured ectopic with <3.5 cm with HR and 4cm without HR

• Molar pregnancy-placental proliferation without fetal tissue, snowstorm pattern in US and increased risk of choriocarcinoma

• Placenta Previa-Dark red blood (painless)

• Placenta abruption-Bright red blood (painful)

• Pregnant patient with seizure-Eclampsia

• Pregnant patient with RUQ/epigastric pain with N/V-HEELP

• Pregnant patient with HA or Stroke like symptom-think CVST

• Ferning and nitrazine paper (blue)=amniotic fluid (think PROM)

• Turtle sign-Shoulder dystocia with head retracting back

• ICH-the most frequent cause of death in breech delivery

• Person carrying turtle or Iguana or eating

eggs and poultry-Think Salmonella• AGE, Typhoid fever cramps, Skin lesion

called rose spots

• Pulse-temperature dissociation

• Shigella- febrile seizure in children with diarrhea

• Campylobactar-Most common cause of bacterial diarrhea in US

• Yersinis-exposure to animal with RLQ pain showing psedo-appendicitis

• E-coli 0157:H7-undercooked beef causing HUS, TTP

• Vibrio Parahaemolyticus-shellfish or raw seafood with N/V, cramps, fever, diarrhea

• Vibrio Vulnificus-shellfish, raw seafood with leg/scrotal necrotizing fasciatitis

• Staph aureus: Most common food poisoning

• 4-6 hours of ingestion

• Bacillus cereus-contaminated Fried Rice• Vibrio Cholera-Rice water stool, severe

dehydration• Scambroid-bacteria in dark meat fish (mahi-mahi,

tuna, mackerel), metallic or peppery taste, histamine release facial flushing, edema

• Ciguatera-neurotoxin in carnivorous fish (snapper, grouper, barracuda), paresthesia, reversal of hot and cold sensation, teeth falling out senation

• Aeromonas hydrophila-Fresh water, well water, or spring water causing diarrhea, vomiting, abd pain

• Rose gardener disease-Sporotichosis

• Filipino living in Baskersfield, CA with cough and rash-Cocciomyocosis

• Bilateral Bells palsy-Borrelia Burgdorferi

• Pericarditis-Coxackie virus

• Fresh water infection-Aeromonas

• Travel to Hawaii, fever with MOSF-think Leptospirosis

• Human bites-Eikenella Corrodans

• Cat or Dog bites-Pasteurella

• Fish tank granuloma (aquarium granuloma)-Mycobacterium marinum

• Lamictal-Steven Johnson Syndrome or DRESS syndrome

• Ethambutal-Chorioretinitis

• Lindane-Seizure

• Pentamidine-Hypoglycemia

• Crixovan-Radiolucent renal stone

• WBC counts of 30,000 with lymphocytosis with chronic cough-Pertussis

• HA with hyponatremia and rash-RMSF

• Travel to North Carolina with fever and rash-RMSF

• Skin rash, cough, hypoxia-think fungal

• Herpangina-Coxackie virus

• Epiglottitis-H Influenza B (HIB)

• Epidemic tracheitis-Staph

• Croup-Parainfluenza Virus

• Tonsillar Pseudomembraine-Diphtheria

• Attic, Closet, Woodpile-Loxosceles reclusa (Brown recluse)

• Insect bite with rigid abdomen-Lactrodactus (black widow)

• Yellow bug-Centruroides (Scorpion bites)

• Rust Removal-HF acid

• Rice water diarrhea-Vibrio Cholera

• Garage or greenhouse-organophosphate

• Camping-RMSF, Giardia, Tick paralysis

• Sea envonomation:

• Boney Fish like lion fish, scorpion fish stonefish, and Stingray-Hot water and analgesics

• Cnidaria(jelly fish, Portuguese man of war, corals-remove neumatocytes and acetic acid

• Something that punctures you: Hot water

• Something that sting/burning: Acetic Acid

• Snakes: Crotalidae (rattlesnakes, copperhead, moccasins) and Elapidae (coral snakes) Immediate vs delayed and less local on coral. Both antivenin

• “Red on yellow kill a fellow, red on black venon lack”

• Septic arthritis-cloudy, yellow, >50,000 with >50% PMN, >50% cx positive, no crystals

• Spinal Epidural Abscess-Back pain, fever with neurologic deficit. DM, IVDA, recent surgery. Staph aureus

• Skiers-Gamekeeper’s thumb with ulnar collateral ligaments, check for laxity, thumb spica

• Snowboarders-Lateral process of Talus

• Bull riders-radial collateral ligament

• Tennis players-blowout injury of medial aspect of gastronecmius

• Maids-patellar bursitis

• Chauffeur’s fracture-Fracture of radial styloid process (car backfired while the chauffeur wans hand cranking to start the car)

• Malgagnes/Montaggia/Galeazzi/Maisonneuve fx

Amazing!Amazing!

Intriguing!Intriguing!

EKG’sEKG’s

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Bonus: Syncope Diagnosis?Bonus: Syncope Diagnosis?

ComputerizedComputerizedTomographyTomography

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>6mm

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OphthamologyOphthamology

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BonusBonusWhich one Which one is which?is which?

AbdominalAbdominalRadiographyRadiography

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BoneyBoneyRadiographyRadiography

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BonusBonus Classic Classic Fractures:Fractures: name themname them

BonusBonus Classic Classic Fractures:Fractures: name themname them

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“Lightbulb”

Bonus: Which is which?Bonus: Which is which?

UltrasoundUltrasound

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Comet Tails and Lung Sliding

PTX

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DermatologyDermatologyand and

Infectious Infectious DiseaseDisease

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KidsKids

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Phimosis versusPhimosis versusParaphimosisParaphimosis

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Environmental-ToxEnvironmental-Tox

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