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This updated episode of CRACKCast reviews Chapter 40 - Genitourinary System in Rosen's 9th Edition.

Core Questions   Outline the anatomic borders of the anterior and posterior triangles of the neck. Detail the borders and associated contents of the three zones of the neck.(Box 37.1) List 5 hard and 5 soft signs of penetrating neck trauma (Box 37.2) List 5 hard and 5 soft signs of vascular injury  Outline an approach to the management of a patient with a hemorrhaging penetrating neck wound. Describe the management of a patient with a suspected venous air embolism. Outline the steps in performing an awake intubation. Outline the indications for imaging to screen for blunt cerebrovascular injury.(Table 37.2) Detail the appropriate imaging studies to order in the patient at risk for or with suspected blunt cerebrovascular injury.   Wisecracks   What structure, if violated, should make you suspect injury to the deep tissues of the neck? What study or studies is/are indicated to evaluate a patient for suspected esophageal injury. List 4 mechanisms of morbidity and mortality that occur as the result of vascular injury in the neck. What is the most common mechanism of injury causing blunt cerebrovascular injury? List 3 mechanisms that cause pulmonary edema in a patient post-hanging.

Core Questions   Outline the anatomic borders of the anterior and posterior triangles of the neck. Detail the borders and associated contents of the three zones of the neck.(Box 37.1) List 5 hard and 5 soft signs of penetrating neck trauma (Box 37.2) List 5 hard and 5 soft signs of vascular injury  Outline an approach to the management of a patient with a hemorrhaging penetrating neck wound. Describe the management of a patient with a suspected venous air embolism. Outline the steps in performing an awake intubation. Outline the indications for imaging to screen for blunt cerebrovascular injury.(Table 37.2) Detail the appropriate imaging studies to order in the patient at risk for or with suspected blunt cerebrovascular injury.   Wisecracks   What structure, if violated, should make you suspect injury to the deep tissues of the neck? What study or studies is/are indicated to evaluate a patient for suspected esophageal injury. List 4 mechanisms of morbidity and mortality that occur as the result of vascular injury in the neck. What is the most common mechanism of injury causing blunt cerebrovascular injury? List 3 mechanisms that cause pulmonary edema in a patient post-hanging.

Core Questions   Outline the Denis Classification system for determining the stability of spinal injuries List 5 flexion, 2 flexion-rotation, 3 extension, and 2 vertical compression spinal injuries (Table 36.1) Wedge Fracture  Flexion Teardrop Fracture Clay Shoveler's Fracture Spinal Subluxation Bilateral Facet Dislocation Altlanto-occipital Dislocation Anterior Atlanto-axial Dislocation Unilateral Facet Dislocation Posterior Neural Arch Fracture Hangman's Fracture Extension Tear Drop Fracture Burst Fracture Jefferson Fracture Outline the mechanisms and potential complications of the following injuries: How are odontoid fractures classified and what causes them? Organize the spinal motor, sensory, and reflex examinations based on spinal levels. (Tables 36.3, 36.4, 36.5) Central Cord Anterior Cord Brown-Sequard Detail the following cord syndromes:  List the components of the following imaging decision-making tools: Canadian C-Spine Rule, NEXUS C-Spine Rule.   Wisecracks   How do you calculate Power's Ratio and why is it important? What injuries is the open-mouth odontoid radiograph best at visualizing? How are whiplash-associated injuries classified? At what spinal level would you expect an injury to potentially cause Horner's Syndrome? What is spinal shock and what physical exam finding indicates its end?

Core Questions   Outline the Denis Classification system for determining the stability of spinal injuries List 5 flexion, 2 flexion-rotation, 3 extension, and 2 vertical compression spinal injuries (Table 36.1) Wedge Fracture  Flexion Teardrop Fracture Clay Shoveler's Fracture Spinal Subluxation Bilateral Facet Dislocation Altlanto-occipital Dislocation Anterior Atlanto-axial Dislocation Unilateral Facet Dislocation Posterior Neural Arch Fracture Hangman's Fracture Extension Tear Drop Fracture Burst Fracture Jefferson Fracture Outline the mechanisms and potential complications of the following injuries: How are odontoid fractures classified and what causes them? Organize the spinal motor, sensory, and reflex examinations based on spinal levels. (Tables 36.3, 36.4, 36.5) Central Cord Anterior Cord Brown-Sequard Detail the following cord syndromes:  List the components of the following imaging decision-making tools: Canadian C-Spine Rule, NEXUS C-Spine Rule.   Wisecracks   How do you calculate Power's Ratio and why is it important? What injuries is the open-mouth odontoid radiograph best at visualizing? How are whiplash-associated injuries classified? At what spinal level would you expect an injury to potentially cause Horner's Syndrome? What is spinal shock and what physical exam finding indicates its end?

Core Questions   Detail the nerve supply of the face. What bones form the borders of the orbit? Outline the LeFort fracture classification system. What is the tongue blade test and how is it performed? Outline the Ellis System for dental fracture classification. Outline an approach to the management of ingested/aspirated teeth. Describe three techniques for the reduction of anterior TMJ dislocations. List four indications for Panorex X-rays.   Wisecracks   At what age do the following sinuses become aerated: Mastoid Ethmoid Facial Maxillary Sphenoid What is the association between the presence of facial injuries and the presence of intracranial injuries/cervical spine injuries?  What facial lacerations require prophylactic antibiotics? List three solutions in which avulsed teeth can be placed to preserve them.

Core Questions   Detail the nerve supply of the face. What bones form the borders of the orbit? Outline the LeFort fracture classification system. What is the tongue blade test and how is it performed? Outline the Ellis System for dental fracture classification. Outline an approach to the management of ingested/aspirated teeth. Describe three techniques for the reduction of anterior TMJ dislocations. List four indications for Panorex X-rays.   Wisecracks   At what age do the following sinuses become aerated: Mastoid Ethmoid Facial Maxillary Sphenoid What is the association between the presence of facial injuries and the presence of intracranial injuries/cervical spine injuries?  What facial lacerations require prophylactic antibiotics? List three solutions in which avulsed teeth can be placed to preserve them.

Core Questions   Define mild, moderate, and severe TBI (including Box 34.1).  Explain the concepts of cerebral autoregulation and CPP. Why is this clinically relevant?  Primary and secondary brain injury.  direct and indirect brain injury.  Differentiate between:  Describe the 4 herniation syndromes  List the extra-axial brain injuries  List the intra-axial brain injuries  Outline your approach to the clinical assessment of the brain injured patient (including GCS and brainstem reflexes).  Describe key imaging findings in the main types of traumatic brain injury.  Inititial resuscitation  ICP management and hyperosmolar therapy Indications for seizure and antibiotic prophylaxis  Reversal of anticoagulation  Decompressive therapies  Outline your management priorities in TBI with respect to:  List the complications of TBI.  Wisecracks What are the layers of the scalp?  What is the Munro-Kellie doctrine?  What is Cushing’s reflex?  List the clinical features of basal skull fracture (Box 34.2)  Describe 3 clinical decision rules that apply to  neuroimaging in mild TBI.  Describe a graduated return to play protocol as per Rosen’s. 

Core Questions   Define mild, moderate, and severe TBI (including Box 34.1).  Explain the concepts of cerebral autoregulation and CPP. Why is this clinically relevant?  Primary and secondary brain injury.  direct and indirect brain injury.  Differentiate between:  Describe the 4 herniation syndromes  List the extra-axial brain injuries  List the intra-axial brain injuries  Outline your approach to the clinical assessment of the brain injured patient (including GCS and brainstem reflexes).  Describe key imaging findings in the main types of traumatic brain injury.  Inititial resuscitation  ICP management and hyperosmolar therapy Indications for seizure and antibiotic prophylaxis  Reversal of anticoagulation  Decompressive therapies  Outline your management priorities in TBI with respect to:  List the complications of TBI.  Wisecracks What are the layers of the scalp?  What is the Munro-Kellie doctrine?  What is Cushing’s reflex?  List the clinical features of basal skull fracture (Box 34.2)  Describe 3 clinical decision rules that apply to  neuroimaging in mild TBI.  Describe a graduated return to play protocol as per Rosen’s. 

Core Questions What are the injuries for the following blunt trauma mechanisms: Head-on collision Rear end collision Lateral (T-bone) collision Rollover Ejected from vehicle Windshield damage Steering wheel damage Dashboard involvement or damage Restraint or seat belt use Air bag deployment Low-speed pedestrian versus automobile High-speed pedestrian versus automobile Bicycle versus automobile Non-automobile-related Vertical impact falls Horizontal impact falls Outline an approach to the primary survey for the trauma patient. Describe the elements of the eFAST exam. Outline an approach to the secondary survey in the trauma patient. Detail relevant ancillary laboratory tests to order in the trauma patient. Canadian CT Head Rule Canadian C-Spine Rule NEXUS C-Spine Rule NEXUS Chest Rule List the components of the following imaging decision-making tool What are the indications for a CT abdomen/pelvis in the trauma patient? Wisecracks What are the mechanisms of injury for the following weapons: Knives Handgun rounds Shotgun rounds Rifle rounds What is the LD50 in feet for falls from a given height? What is permissive hypotension and what evidence does it have? 

Core Questions What are the injuries for the following blunt trauma mechanisms: Head-on collision Rear end collision Lateral (T-bone) collision Rollover Ejected from vehicle Windshield damage Steering wheel damage Dashboard involvement or damage Restraint or seat belt use Air bag deployment Low-speed pedestrian versus automobile High-speed pedestrian versus automobile Bicycle versus automobile Non-automobile-related Vertical impact falls Horizontal impact falls Outline an approach to the primary survey for the trauma patient. Describe the elements of the eFAST exam. Outline an approach to the secondary survey in the trauma patient. Detail relevant ancillary laboratory tests to order in the trauma patient. Canadian CT Head Rule Canadian C-Spine Rule NEXUS C-Spine Rule NEXUS Chest Rule List the components of the following imaging decision-making tool What are the indications for a CT abdomen/pelvis in the trauma patient? Wisecracks What are the mechanisms of injury for the following weapons: Knives Handgun rounds Shotgun rounds Rifle rounds What is the LD50 in feet for falls from a given height? What is permissive hypotension and what evidence does it have? 

Core Questions List key historical red flags in a patient presenting with back pain. (Box 32.1)  List red flags on physical examination of a patient with back pain. (Box 32.1)  List key critical differential diagnoses for a patient presenting with acute back pain (Box 32.2) Describe an approach to the rapid assessment of a patient with acute lower back pain (Fig 32.1)  Describe an approach to ancillary testing and imaging for critical causes of acute back pain (table 32.1)  List the sensory, motor, and screening tests for the lumbar nerve roots L3-S1 (table 32.2)  Describe an overview of the management of acute low back pain (Fig 32.2)  Wisecracks What are 4 variables associated with serious outcomes in patients with back pain (p. 276)  Differentiate between conus medullaris syndrome and cauda equina syndrome.  What physical exam/ancillary findings are most predictive of cauda equina? (CJEM 2020;22(5):652–654)  How does Rosen’s differentiate between disc herniation and radiculopathy?

Core Questions List key historical red flags in a patient presenting with back pain. (Box 32.1)  List red flags on physical examination of a patient with back pain. (Box 32.1)  List key critical differential diagnoses for a patient presenting with acute back pain (Box 32.2) Describe an approach to the rapid assessment of a patient with acute lower back pain (Fig 32.1)  Describe an approach to ancillary testing and imaging for critical causes of acute back pain (table 32.1)  List the sensory, motor, and screening tests for the lumbar nerve roots L3-S1 (table 32.2)  Describe an overview of the management of acute low back pain (Fig 32.2)  Wisecracks What are 4 variables associated with serious outcomes in patients with back pain (p. 276)  Differentiate between conus medullaris syndrome and cauda equina syndrome.  What physical exam/ancillary findings are most predictive of cauda equina? (CJEM 2020;22(5):652–654)  How does Rosen’s differentiate between disc herniation and radiculopathy?

Core Questions Define the following terms: Menorrhagia Metrorrhagia Menometrorrhagia  Oligomenorrhea  What points on history are important to elucidate in the patient with PV bleeding? Outline an approach to the physical examination in the patient with PV bleeding. Describe an approach to ancillary testing in the patient with PV bleeding. Outline the DDx of PV bleeding in the non-pregnant patient. Outline the DDx of PV bleeding in the pregnant patient. Detail an approach to the management of PV bleeding in nonpregnant patients in the ED. Wisecracks What is the average volume of blood lost during typical menstruation? What is the risk of spontaneous abortion in the patient who presents with vaginal bleeding in the first trimester?  List five risk factors for placental abruption. List five risk factors for PPH. List five risk factors for ectopic pregnancy. List five absolute contraindications to the use of oral contraceptive pills.

Core Questions Define the following terms: Menorrhagia Metrorrhagia Menometrorrhagia  Oligomenorrhea  What points on history are important to elucidate in the patient with PV bleeding? Outline an approach to the physical examination in the patient with PV bleeding. Describe an approach to ancillary testing in the patient with PV bleeding. Outline the DDx of PV bleeding in the non-pregnant patient. Outline the DDx of PV bleeding in the pregnant patient. Detail an approach to the management of PV bleeding in nonpregnant patients in the ED. Wisecracks What is the average volume of blood lost during typical menstruation? What is the risk of spontaneous abortion in the patient who presents with vaginal bleeding in the first trimester?  List five risk factors for placental abruption. List five risk factors for PPH. List five risk factors for ectopic pregnancy. List five absolute contraindications to the use of oral contraceptive pills.

Core Questions Outline the anatomic contents of the female pelvis. Describe an approach to the history in a patient with acute pelvic pain. Describe an approach to the physical examination in the patient with acute pelvic pain. List 10 differential diagnoses for the patient presenting with acute pelvic pain. (Box 30.1) Outline an approach to ancillary testing for the patient presenting with acute pelvic pain. What must be seen on bedside ultrasound to confirm a definitive intrauterine pregnancy (IUP)? Wisecracks What is the incidence of domestic violence in patients presenting with pelvic pain?  What is the incidence of heterotopic pregnancy in the general population and in those that have conceived using reproductive technology? Under what circumstances can a pelvic examination be omitted in a patient presenting to the ED with acute pelvic pain? What is the classic triad of pelvic inflammatory disease (PID)?

Core Questions Outline the anatomic contents of the female pelvis. Describe an approach to the history in a patient with acute pelvic pain. Describe an approach to the physical examination in the patient with acute pelvic pain. List 10 differential diagnoses for the patient presenting with acute pelvic pain. (Box 30.1) Outline an approach to ancillary testing for the patient presenting with acute pelvic pain. What must be seen on bedside ultrasound to confirm a definitive intrauterine pregnancy (IUP)? Wisecracks What is the incidence of domestic violence in patients presenting with pelvic pain?  What is the incidence of heterotopic pregnancy in the general population and in those that have conceived using reproductive technology? Under what circumstances can a pelvic examination be omitted in a patient presenting to the ED with acute pelvic pain? What is the classic triad of pelvic inflammatory disease (PID)?

Core Questions List risk factors for constipation . List 10 causes of constipation (Box 29.1). Describe an approach to the history and physical exam of the constipated patient.  What ancillary testing should and should not be ordered in constipation?  Describe an approach to management of constipation in the ED (figure 29.1) . Describe 5 classes of laxative agents. List the lifestyle changes that constipation patients should be counselled about.   Wisecracks List 5 medications that can cause constipation.  What agents can be considered in refractory opioid-induced constipation?  Describe the mechanism of action of PEG 3350.  Describe the mechanism of overflow incontinence.

Core Questions List risk factors for constipation . List 10 causes of constipation (Box 29.1). Describe an approach to the history and physical exam of the constipated patient.  What ancillary testing should and should not be ordered in constipation?  Describe an approach to management of constipation in the ED (figure 29.1) . Describe 5 classes of laxative agents. List the lifestyle changes that constipation patients should be counselled about.   Wisecracks List 5 medications that can cause constipation.  What agents can be considered in refractory opioid-induced constipation?  Describe the mechanism of action of PEG 3350.  Describe the mechanism of overflow incontinence.

Core Questions Define diarrhea. Outline the pathophysiologic processes that result in diarrhea. List 10 infectious causes of diarrhea. - Box 28.1 List 10 non-infectious causes of diarrhea. - Box 28.2 Outline 5 important aspects of a patient’s history to elucidate in cases of diarrhea. Detail an approach to laboratory testing in the patient with diarrhea. When are empiric antibiotics indicated for the treatment of diarrheal illnesses? Wisecracks What antibiotics are most commonly implicated with precipitating C.difficile diarrhea? What factors increase the probability of non-benign diarrheal illness? Outline the constituent ingredients contained within the World Health Organization’s rehydration formula. What is the BRAT diet and why is it recommended in patients with acute diarrheal illnesses?

Core Questions Define diarrhea. Outline the pathophysiologic processes that result in diarrhea. List 10 infectious causes of diarrhea. - Box 28.1 List 10 non-infectious causes of diarrhea. - Box 28.2 Outline 5 important aspects of a patient’s history to elucidate in cases of diarrhea. Detail an approach to laboratory testing in the patient with diarrhea. When are empiric antibiotics indicated for the treatment of diarrheal illnesses? Wisecracks What antibiotics are most commonly implicated with precipitating C.difficile diarrhea? What factors increase the probability of non-benign diarrheal illness? Outline the constituent ingredients contained within the World Health Organization’s rehydration formula. What is the BRAT diet and why is it recommended in patients with acute diarrheal illnesses?

Core Questions   Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location  Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3 List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1 Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1 List five characteristics of patients with high-risk GI bleeds - Box 27.2 Describe an approach to ancillary testing in the patient with GI bleeding. List five substances that when ingested, can result in a falsely-positive stool guaiac study Outline an approach to the management of the patient with GI bleeding - Fig 27.3 Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4   Wisecracks   Outline the three most common causes of UGIB in pediatric and adult patients. Outline the three most common causes of LGIB in pediatric and adult patients. What percentage of patients presenting with hematochezia actually have an UGIB? What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?

Core Questions   Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location  Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3 List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1 Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1 List five characteristics of patients with high-risk GI bleeds - Box 27.2 Describe an approach to ancillary testing in the patient with GI bleeding. List five substances that when ingested, can result in a falsely-positive stool guaiac study Outline an approach to the management of the patient with GI bleeding - Fig 27.3 Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4   Wisecracks   Outline the three most common causes of UGIB in pediatric and adult patients. Outline the three most common causes of LGIB in pediatric and adult patients. What percentage of patients presenting with hematochezia actually have an UGIB? What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?

Core Questions Define the following terms: Nausea Retching Vomiting Outline the neural pathway regulating nausea and vomiting. List 6 potential sequelae of vomiting. Outline an approach to the history in the patient complaining of nausea and vomiting. Outline an approach to the physical exam in the nauseated and/or vomiting patient. List 10 differential diagnoses for the vomiting patient. What ancillary tests are indicated in the patient with nausea and/or vomiting? List five antiemetics that can be used to treat the nauseous and vomiting patient. Wisecracks What are the three phases of vomiting?  What is Hamman’s Sign and what pathology does it point to? What medication is indicated in the patient with intractable chemotherapy-induced nausea and vomiting.

Core Questions Define the following terms: Nausea Retching Vomiting Outline the neural pathway regulating nausea and vomiting. List 6 potential sequelae of vomiting. Outline an approach to the history in the patient complaining of nausea and vomiting. Outline an approach to the physical exam in the nauseated and/or vomiting patient. List 10 differential diagnoses for the vomiting patient. What ancillary tests are indicated in the patient with nausea and/or vomiting? List five antiemetics that can be used to treat the nauseous and vomiting patient. Wisecracks What are the three phases of vomiting?  What is Hamman’s Sign and what pathology does it point to? What medication is indicated in the patient with intractable chemotherapy-induced nausea and vomiting.

Core Questions Explain broad causes of elevated bilirubin (obstructive, hepatocellular, and hemolysis) and the significance of direct vs. indirect hyperbilirubinemia (Fig 25.1) Explain your approach to the history and physical exam in patients with jaundice (Fig 25.2)  List 10 causes of jaundice (Table 25.2)  Explain your approach to ancillary testing in patients with jaundice.  Wisecracks What are the stages of hepatic encephalopathy?   What is the triad of acute hepatic failure?  What is Charcot’s triad and Reynold’s pentad?  What is the “1000s Club” and how do you become a member? 

Core Questions Explain broad causes of elevated bilirubin (obstructive, hepatocellular, and hemolysis) and the significance of direct vs. indirect hyperbilirubinemia (Fig 25.1) Explain your approach to the history and physical exam in patients with jaundice (Fig 25.2)  List 10 causes of jaundice (Table 25.2)  Explain your approach to ancillary testing in patients with jaundice.  Wisecracks What are the stages of hepatic encephalopathy?   What is the triad of acute hepatic failure?  What is Charcot’s triad and Reynold’s pentad?  What is the “1000s Club” and how do you become a member? 

Core Questions What are risk factors for serious underlying causes of abdominal pain? (Box 24.1)  Explain key symptoms and signs to look for in the evaluation of the patient with abdominal pain.  What diagnoses are associated with different patterns of abdominal pain? (Fig 24.1)  List 5 critical and 5 emergent causes of abdominal pain (Table 24.1, 24.2)  Explain an approach to ancillary testing in abdominal pain.  Outline a diagnostic algorithm for patients with abdominal pain (Fig 24.4)  Outline an empiric management algorithm for abdominal pain. (Fig 24.5)  Wisecracks What are the structures included in the foregut, midgut, and hindgut? More importantly, why do you care?  List indications for bedside US in the ED patient with abdominal pain (Table 24.3)  Explain how referred pain works in the setting of abdominal pain (Fig 24.2)    

Core Questions What are risk factors for serious underlying causes of abdominal pain? (Box 24.1)  Explain key symptoms and signs to look for in the evaluation of the patient with abdominal pain.  What diagnoses are associated with different patterns of abdominal pain? (Fig 24.1)  List 5 critical and 5 emergent causes of abdominal pain (Table 24.1, 24.2)  Explain an approach to ancillary testing in abdominal pain.  Outline a diagnostic algorithm for patients with abdominal pain (Fig 24.4)  Outline an empiric management algorithm for abdominal pain. (Fig 24.5)  Wisecracks What are the structures included in the foregut, midgut, and hindgut? More importantly, why do you care?  List indications for bedside US in the ED patient with abdominal pain (Table 24.3)  Explain how referred pain works in the setting of abdominal pain (Fig 24.2)    

Core Questions Describe an approach to key history and physical exam for chest pain patients presenting to the ED. (Table 23.2 and 23.3)  List 5 critical diagnoses, 5 emergent, and 5 nonemergent diagnoses to consider in the patient presenting with chest pain. (Table 23.1) Describe an approach to the critically ill patient with undifferentiated chest pain. (Figure 23.1) Describe an approach to ancillary testing in chest pain. (Table 23.4 and 23.5) List the risk factors associated with each critical chest pain diagnosis (Box 23.1)  Explain the approach to risk stratification of ED chest pain patients.  Wisecracks What are the X-ray findings of aortic dissection?  What are your HR and BP targets in Aortic dissection?  List the components of the HEART score. 

Core Questions Describe an approach to key history and physical exam for chest pain patients presenting to the ED. (Table 23.2 and 23.3)  List 5 critical diagnoses, 5 emergent, and 5 nonemergent diagnoses to consider in the patient presenting with chest pain. (Table 23.1) Describe an approach to the critically ill patient with undifferentiated chest pain. (Figure 23.1) Describe an approach to ancillary testing in chest pain. (Table 23.4 and 23.5) List the risk factors associated with each critical chest pain diagnosis (Box 23.1)  Explain the approach to risk stratification of ED chest pain patients.  Wisecracks What are the X-ray findings of aortic dissection?  What are your HR and BP targets in Aortic dissection?  List the components of the HEART score. 

Core Questions Define the following terms: Dyspnea Tachypnea Hyperpnea Hyperventilation Dyspnea on exertion Orthopnea Paroxysmal Nocturnal Dyspnea What anatomical structures are responsible for controlling respiratory effort? Outline an approach to the history for the dyspneic patient. Detail the physical examination for the dyspneic patient and highlight pivotal exam findings that point to specific pathologies. Outline the differential diagnosis for the patient presenting with dyspnea and highlight 5 critical, 5 emergent, and 5 non-emergent causes of shortness of breath. What ancillary tests are indicated for the dyspneic patient? Detail the utility of point-of-care ultrasound in the assessment of the dyspneic patient. Outline a management algorithm for the acutely dyspneic patient. Wisecracks List three findings on chest radiograph suggestive of pulmonary embolism. What is the utility of venous blood gas testing and how do its values correlate with that of an arterial blood gas?

Core Questions Define the following terms: Dyspnea Tachypnea Hyperpnea Hyperventilation Dyspnea on exertion Orthopnea Paroxysmal Nocturnal Dyspnea What anatomical structures are responsible for controlling respiratory effort? Outline an approach to the history for the dyspneic patient. Detail the physical examination for the dyspneic patient and highlight pivotal exam findings that point to specific pathologies. Outline the differential diagnosis for the patient presenting with dyspnea and highlight 5 critical, 5 emergent, and 5 non-emergent causes of shortness of breath. What ancillary tests are indicated for the dyspneic patient? Detail the utility of point-of-care ultrasound in the assessment of the dyspneic patient. Outline a management algorithm for the acutely dyspneic patient. Wisecracks List three findings on chest radiograph suggestive of pulmonary embolism. What is the utility of venous blood gas testing and how do its values correlate with that of an arterial blood gas?

Core Questions:    Define “massive hemoptysis”. Which vessels, when injured, are typically associated with small and massive hemoptysis, and how do the vessel characteristics influence the degree of bleeding? Outline an approach to the history and physical examination for a patient presenting with hemoptysis. Outline the differential diagnosis for hemoptysis and highlight five critical and five emergent diagnoses that cause hemoptysis. (Box 21.1 and 21.2) What ancillary tests are warranted in the patient with hemoptysis? Detail the utility of imaging studies in patients with hemoptysis. Detail the diagnostic approach to the patient with hemoptysis. (Figure 21.1) Outline an approach to managing the patient with hemoptysis. (Figure 21.2) What two maneuvers can be used to address massive hemoptysis from a suspected tracheo-innominate fistula (TIF)? What strategies can be used to improve oxygenation in the patient with massive hemoptysis? Wisecracks:  List one gynecologic cause of hemoptysis. List five causes of massive hemoptysis. What is the most lethal consequence of massive hemoptysis?

Core Questions:    Define “massive hemoptysis”. Which vessels, when injured, are typically associated with small and massive hemoptysis, and how do the vessel characteristics influence the degree of bleeding? Outline an approach to the history and physical examination for a patient presenting with hemoptysis. Outline the differential diagnosis for hemoptysis and highlight five critical and five emergent diagnoses that cause hemoptysis. (Box 21.1 and 21.2) What ancillary tests are warranted in the patient with hemoptysis? Detail the utility of imaging studies in patients with hemoptysis. Detail the diagnostic approach to the patient with hemoptysis. (Figure 21.1) Outline an approach to managing the patient with hemoptysis. (Figure 21.2) What two maneuvers can be used to address massive hemoptysis from a suspected tracheo-innominate fistula (TIF)? What strategies can be used to improve oxygenation in the patient with massive hemoptysis? Wisecracks:  List one gynecologic cause of hemoptysis. List five causes of massive hemoptysis. What is the most lethal consequence of massive hemoptysis?

Core Questions:    What are the three anatomically-distinct zones of the pharynx, and what structures outline their borders? Ultrasound of the Neck Lateral neck radiograph Nasopharyngoscopy CT Soft Tissues Neck Describe the utility of the following imaging modalities in the patient with sore throat. Outline five viral, five bacterial, and five other potential aetiologies of sore throat in the ED patient? (Table 20.1) Outline the components of the Modified Centor Score and describe its application. Describe the diagnostic algorithm for the patient with sore throat. (Figure 20.4) Outline the approach to managing a patient with sore throat in the ED. (Figure 20.4) What antibiotics can be used in the  patient with suspected or confirmed streptococcal pharyngitis? (Box 20.2)   Wisecracks:    In what age groups is streptococcal pharyngitis rarely seen? What is Waldeyer’s Tonsillar Ring? What is the “thumb sign” and what pathology does it point to?

Core Questions:    What are the three anatomically-distinct zones of the pharynx, and what structures outline their borders? Ultrasound of the Neck Lateral neck radiograph Nasopharyngoscopy CT Soft Tissues Neck Describe the utility of the following imaging modalities in the patient with sore throat. Outline five viral, five bacterial, and five other potential aetiologies of sore throat in the ED patient? (Table 20.1) Outline the components of the Modified Centor Score and describe its application. Describe the diagnostic algorithm for the patient with sore throat. (Figure 20.4) Outline the approach to managing a patient with sore throat in the ED. (Figure 20.4) What antibiotics can be used in the  patient with suspected or confirmed streptococcal pharyngitis? (Box 20.2)   Wisecracks:    In what age groups is streptococcal pharyngitis rarely seen? What is Waldeyer’s Tonsillar Ring? What is the “thumb sign” and what pathology does it point to?

Core Questions:    Detail the pertinent points to review when taking the history of a patient presenting with a red and painful eye - Box 19.2 Outline an approach to the ocular physical examination - Box 19.3 Outline the components of the slit lamp examination - Box 19.4  What signs and symptoms, if present, likely indicate the presence of serious ocular pathologies - Box 19.1 What is a relative afferent pupillary defect and what conditions cause it? List ten causes of increase intraocular pressure List five causes for an absent red reflex - Box 19.5 Name three critical, emergent, urgent, and non-urgent causes of the red and painful eye? - Figure 19.8   Wisecracks:    What are the fundoscopic findings of a central retinal artery occlusion. What is the pinhole test and what visual disturbances does it correct? What are the three most common causes of an irregularly shaped pupil What is Seidel’s Test and what condition does it identify?

Core Questions:    Detail the pertinent points to review when taking the history of a patient presenting with a red and painful eye - Box 19.2 Outline an approach to the ocular physical examination - Box 19.3 Outline the components of the slit lamp examination - Box 19.4  What signs and symptoms, if present, likely indicate the presence of serious ocular pathologies - Box 19.1 What is a relative afferent pupillary defect and what conditions cause it? List ten causes of increase intraocular pressure List five causes for an absent red reflex - Box 19.5 Name three critical, emergent, urgent, and non-urgent causes of the red and painful eye? - Figure 19.8   Wisecracks:    What are the fundoscopic findings of a central retinal artery occlusion. What is the pinhole test and what visual disturbances does it correct? What are the three most common causes of an irregularly shaped pupil What is Seidel’s Test and what condition does it identify?

Core Questions:    What is diplopia and how is it classified? What four questions help clinicians delineate the potential cause of a patient’s diplopia? What are the cardinal directions of gaze and how are they tested? Outline the physical exam for the patient with monocular and binocular diplopia. Outline the DDx for monocular diplopia? Outline the DDx for binocular diplopia? [Table 18.1] Detail the different oculomotor palsies. [Figure 18.3] Detail the various lacunar stroke syndromes. [Box 18.1] Define internuclear ophthalmoplegia. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4]   Wisecracks:    What are the most common oculomotor palsies and what causes them? What is orbital apex syndrome? What is the “rule of the pupil” and how reliable is it? Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

Core Questions:    What is diplopia and how is it classified? What four questions help clinicians delineate the potential cause of a patient’s diplopia? What are the cardinal directions of gaze and how are they tested? Outline the physical exam for the patient with monocular and binocular diplopia. Outline the DDx for monocular diplopia? Outline the DDx for binocular diplopia? [Table 18.1] Detail the different oculomotor palsies. [Figure 18.3] Detail the various lacunar stroke syndromes. [Box 18.1] Define internuclear ophthalmoplegia. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4]   Wisecracks:    What are the most common oculomotor palsies and what causes them? What is orbital apex syndrome? What is the “rule of the pupil” and how reliable is it? Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

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Just a bunch of crackheads living in a building together. Check out my Youtube Channel! https://www.youtube.com/channel/UCYWNYHFqTGd6yvyvi5Rravg? Catch me on Twitch: https://www.twitch.tv/kneipfilms Clothe thyself: https://teespring.com/stores/kneip-films --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/crack-cast/message

Core Questions:    List three primary headache disorders Describe the pathophysiology of migraines and name three Emergency Department treatments for same List five critical and five emergent causes of headache (Table 17.1) Outline your approach to the history for the patient presenting with headache ( Box 17.1) Outline your approach to the physical exam for the patient presenting with headache (Table 17.3) Describe your diagnostic approach to the patient with a suspected SAH Detail the findings on LP that would suggest your patient has bacterial meningitis Wisecracks:    What percentage of patients presenting with headache to the ED have a SAH? Outline the SNOOP MEETS Pregnancy mnemonic Which diagnostic test is best to establish the diagnosis of cerebral venous sinus thrombosis? Detail how to elicit Kernig’s and Brudzinski’s Sign 

Core Questions:    List three primary headache disorders Describe the pathophysiology of migraines and name three Emergency Department treatments for same List five critical and five emergent causes of headache (Table 17.1) Outline your approach to the history for the patient presenting with headache ( Box 17.1) Outline your approach to the physical exam for the patient presenting with headache (Table 17.3) Describe your diagnostic approach to the patient with a suspected SAH Detail the findings on LP that would suggest your patient has bacterial meningitis Wisecracks:    What percentage of patients presenting with headache to the ED have a SAH? Outline the SNOOP MEETS Pregnancy mnemonic Which diagnostic test is best to establish the diagnosis of cerebral venous sinus thrombosis? Detail how to elicit Kernig’s and Brudzinski’s Sign 

Just a bunch of crackheads living in a building together. 01Beaker Channel: https://www.youtube.com/channel/UCWaVhzQPM4lxPQ1MoR0f_gg 02Beaker Channel: https://www.youtube.com/channel/UChpjNxgxdTXbhOVvKvdNIkA Crackcast Channel: https://www.youtube.com/channel/UCxWdSU43BrLajWn5IUxVKWg Lucas Kneip Channel: https://www.youtube.com/channel/UCF7NxDtwGjdOtFmWE4BrLNw? Kneip Films: https://www.youtube.com/channel/UCYWNYHFqTGd6yvyvi5Rravg White Lotus Channel: https://www.youtube.com/channel/UCbt-hPncnOTCcMte-2UqtSA Catch me on Twitch: https://www.twitch.tv/kneipfilms Clothe thyself: https://teespring.com/stores/kneip-films --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/crack-cast/message

Just a bunch of crackheads living in a building together. Crackcast Channel: https://www.youtube.com/channel/UCxWdSU43BrLajWn5IUxVKWg Lucas Kneip Channel: https://www.youtube.com/channel/UCF7NxDtwGjdOtFmWE4BrLNw? Kneip Films: https://www.youtube.com/channel/UCYWNYHFqTGd6yvyvi5Rravg White Lotus Channel: https://www.youtube.com/channel/UCbt-hPncnOTCcMte-2UqtSA Catch me on Twitch: https://www.twitch.tv/kneipfilms Clothe thyself: https://teespring.com/stores/kneip-films --- Send in a voice message: https://anchor.fm/crack-cast/message

Just a bunch of crackheads living in a building together. Check out my Youtube Channel! https://www.youtube.com/channel/UCYWNYHFqTGd6yvyvi5Rravg? Catch me on Twitch: https://www.twitch.tv/kneipfilms Clothe thyself: https://teespring.com/stores/kneip-films --- Send in a voice message: https://anchor.fm/crack-cast/message

Core Questions:    What is dizziness and what pathologies can cause it? Define vertigo and acute vestibular syndrome What three systems are involved in the maintenance of equilibrium and how many of these systems must be affected to cause vertigo? Trace the neuronal impulse from the vestibular apparatus to the muscle endplate Define nystagmus List five peripheral causes of vertigo (see Table 16.2) List five central causes of vertigo (see Table 16.2) Differentiate between central and peripheral vertigo based on history and clinical exam findings Describe the Dix Hallpike Test Outline your approach to the HINTS exam What is the Epley maneuver and what pathology does it treat? Describe the Barbecue Roll Test and what pathology does it treat? Outline your approach to managing the vertiginous patient   Wisecracks:    What diagnoses cause both vertigo and hearing loss? What features of nystagmus suggest a central pathology? What is truncal ataxia and what typically causes it?

Core Questions:    What is dizziness and what pathologies can cause it? Define vertigo and acute vestibular syndrome What three systems are involved in the maintenance of equilibrium and how many of these systems must be affected to cause vertigo? Trace the neuronal impulse from the vestibular apparatus to the muscle endplate Define nystagmus List five peripheral causes of vertigo (see Table 16.2) List five central causes of vertigo (see Table 16.2) Differentiate between central and peripheral vertigo based on history and clinical exam findings Describe the Dix Hallpike Test Outline your approach to the HINTS exam What is the Epley maneuver and what pathology does it treat? Describe the Barbecue Roll Test and what pathology does it treat? Outline your approach to managing the vertiginous patient   Wisecracks:    What diagnoses cause both vertigo and hearing loss? What features of nystagmus suggest a central pathology? What is truncal ataxia and what typically causes it?