EM Boards Survival Guide: Mixed Content 1

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)

Inservice exam is just around the corner. This week’s EM Boards Survival Guide provides you with some quick key points for the exam.

Boards Must-Knows:

1) Bacterial pneumonia: Bugs to know; recommend making a chart of bug / patient risk factors + presentation / effective antibiotics / Strep. pneumo / Staph. aureus / Pseudomonas / H. influenzae / Klebsiella / Legionella / Mycoplasma / Chlamydophila.

2) Pyloric stenosis: Male, 2-8 weeks old. Non-bilious projectile vomiting, then hungry again. RUQ/MEG palpable olive-shaped mass. Labs with hypochloremic hypokalemic metabolic alkalosis. Diagnosis: US; UGI series. Treatment: surgery.

3) Corneal abrasion: Patient with tearing, pain, redness, FB sensation, sensitivity to light. Topical anesthetic relieves pain. Diagnose with fluorescein stain. Consider FB under lid if multiple corneal abrasions identified. Treatment: topical erythromycin unless contact lens wearer (tobramycin, gentamicin, or ciprofloxacin – cover Pseudomonas).

4) Legionella pneumonia: Causes epidemics. Water source. Consider when PNA + GI symptoms. Labs classically with hyponatremia and elevated LFTs. Know classic chest x-ray. Treatment: azithromycin or fluoroquinolone.

5) Digoxin toxicity: Inhibits Na/K ATPase. Acute toxicity (ingestion) vs chronic (worsening renal function, recent dose change). Most common ECG finding include PVCs (remember, almost any rhythm can occur (except atrial fibrillation with RVR)). Higher potassium levels => worse outcomes. Treatment: DigiFab. Know indications for treatment.

6) Pertussis: Consider in patients with flu-like illness (catarrhal => paroxysmal => convalescent). Bug: B. pertussis. Coughing fits followed by inspiratory stridor and post-tussive emesis. Treatment: macrolide

7) NEXUS C-spine Criteria: https://www.mdcalc.com/nexus-criteria-c-spine-imaging=> does your patient need C-spine imaging?

8) Meningitis: Know classic signs/symptoms/physical exam findings, although these may not be reliable in real life. Most common cause is S. pneumo. College student, think N. meningitidis. HIV/AIDS patient, consider Cryptococcus. Start antibiotics if the head CT and/or LP is delayed for any reason. Empiric antibiotics = vancomycin + ceftriaxone. Concern for HSV, add acyclovir. Concern for Listeria, add ampicillin.

9) GHB toxicity: Classically patient at nightclub or fit bodybuilder with respiratory depression/GCS 3, requiring intubation and several hours later pulls out ETT and is basically back to baseline.

10) SVC syndrome: Patient with shortness of breath (#1 symptom) + facial redness + upper extremity swelling + distended neck and chest veins. Most common cause is cancer. Treatment: radiation therapy, stenting, steroid.