Clinical Pearls

strict warning: Non-static method view::load() should not be called statically in /var/www/html/prod-lijed/sites/all/modules/views/views.module on line 823.
strict warning: Declaration of views_plugin_display::options_validate() should be compatible with views_plugin::options_validate(&$form, &$form_state) in /var/www/html/prod-lijed/sites/all/modules/views/plugins/views_plugin_display.inc on line 1684.
strict warning: Declaration of views_plugin_display_block::options_submit() should be compatible with views_plugin_display::options_submit(&$form, &$form_state) in /var/www/html/prod-lijed/sites/all/modules/views/plugins/views_plugin_display_block.inc on line 184.
strict warning: Declaration of views_plugin_display_page::options_submit() should be compatible with views_plugin_display::options_submit(&$form, &$form_state) in /var/www/html/prod-lijed/sites/all/modules/views/plugins/views_plugin_display_page.inc on line 457.
strict warning: Declaration of views_handler_field_broken::ui_name() should be compatible with views_handler::ui_name($short = false) in /var/www/html/prod-lijed/sites/all/modules/views/handlers/views_handler_field.inc on line 243.
strict warning: Declaration of content_handler_field::options() should be compatible with views_object::options() in /var/www/html/prod-lijed/sites/all/modules/cck/includes/views/handlers/content_handler_field.inc on line 170.
strict warning: Declaration of views_handler_sort_broken::ui_name() should be compatible with views_handler::ui_name($short = false) in /var/www/html/prod-lijed/sites/all/modules/views/handlers/views_handler_sort.inc on line 82.
strict warning: Declaration of views_handler_filter::options_validate() should be compatible with views_handler::options_validate($form, &$form_state) in /var/www/html/prod-lijed/sites/all/modules/views/handlers/views_handler_filter.inc on line 584.
strict warning: Declaration of views_handler_filter::options_submit() should be compatible with views_handler::options_submit($form, &$form_state) in /var/www/html/prod-lijed/sites/all/modules/views/handlers/views_handler_filter.inc on line 584.
strict warning: Declaration of views_handler_filter_broken::ui_name() should be compatible with views_handler::ui_name($short = false) in /var/www/html/prod-lijed/sites/all/modules/views/handlers/views_handler_filter.inc on line 608.
strict warning: Declaration of views_plugin_style_default::options() should be compatible with views_object::options() in /var/www/html/prod-lijed/sites/all/modules/views/plugins/views_plugin_style_default.inc on line 25.
strict warning: Declaration of views_plugin_row::options_validate() should be compatible with views_plugin::options_validate(&$form, &$form_state) in /var/www/html/prod-lijed/sites/all/modules/views/plugins/views_plugin_row.inc on line 61.
strict warning: Declaration of views_plugin_row::options_submit() should be compatible with views_plugin::options_submit(&$form, &$form_state) in /var/www/html/prod-lijed/sites/all/modules/views/plugins/views_plugin_row.inc on line 61.
strict warning: Non-static method view::load() should not be called statically in /var/www/html/prod-lijed/sites/all/modules/views/views.module on line 823.
strict warning: Non-static method view::load() should not be called statically in /var/www/html/prod-lijed/sites/all/modules/views/views.module on line 823.
strict warning: Non-static method view::load() should not be called statically in /var/www/html/prod-lijed/sites/all/modules/views/views.module on line 823.

Posted on 08/11/2009

Which two murmurs grow louder during a valsalva maneuver?

Answer

Mitral valve prolapse (MVP) and hypertrophic obstructive cardiomyopathy (HOCM)

Most murmurs decrease with decreased preload (induced by valsalva maneuvers). This is because less blood equals, less flow, equals less turbulence and therefore, decreased murmur. The opposite is true with MVP and HOCM. In the case of MVP, the chordae and valves slacken and become floppier with decreased chamber size. With HOCM, decreased chamber size results in relatively greater obstruction of the ventricular septum.

Beta blockade increased filling time and therefore ventricular size and leads to a reduction in murmur.

Posted on 06/30/2009

What is the normal predental space on a lateral c-spine xray in an adult?

Answer

3mm in an adult

5mm in a child

Posted on 06/22/2009

What is the CDC recommended treatment for epididymitis?

Answer

In general, treat men for GC/C. Trachomatis.

Ceftriaxone 250 mg IM PLUS Doxycycline 100 mg BID for 10 days

In men who are at risk for infections caused by enteric organisms (elderly, diabetics, HIV, those that participate in anal intercourse) and those allergic to cephalosporins and/or doxycycline:

Levaquin 500 mg BID for 10 days or Ofloxacin 300 mg BID for 10 days

Posted on 06/17/2009

Which toxic alcohols produce an anion gap metabolic acidosis?

Answer

Methanol and Ethylene Glycol are metabolized into formic acid and glyoxolic acid, respectively. The metabolites are responsible for the toxicity of these compounds and will cause an anion gap metabolic acidosis.

EtOH and Isopropyl alcohol do not cause a metabolic acidosis.

All toxic alcohols cause an osmolar gap.

Posted on 05/21/2009

What is the treatment sequence for acute angle closure glaucoma?

Answer

There are three main medications that are used to manage acute angle closure glaucoma:

1. B-Blocker drops: reduces aqueous humor production and decreases IOP

2. Miotic drops: these cause the trabecular meshwork to move away form the peripheral iris to improve drainage of the aqueous fluid.

3. Systemic Carbonic Anhydrase inhibitors: decreases bicarbonate production of the cilliary body and decreases production of aqueous humor.

Topical steroids and alpha agonist drops are also used to manage acute glaucoma.

Posted on 05/01/2009

How much factor is necessary to completely reverse a hemophiliac that is factor VIII deficient? Factor IX deficent?

Answer

50u/kg will completely restore circulating factor VIII to 100% and should be given to all hemophiliacs that are even suspected to have life threatening bleeding... this should be administered before any imaging or tests are ordered. Once the factor is given; one may then confirm the suscpicion and extent of the bleed.

To completely restore circulating factor IX to 100%, one should give 100u/kg of factor IX.

Posted on 04/21/2009

What is the most commonly injured ligament of the ankle?

Answer

The anterior talo-fibular ligament will be injured most commonly in an ankle sprain.

Posted on 03/17/2009

What are common injuries one should evaluate for when a patient falls on an outstreched hand?

Answer

1. Scaphoid bone fx

2. Lunate/ perilunate dislocation

3. Radial head dislocation

4. AC separation

5. Posterior shoulder dislocation

Posted on 03/12/2009

What is the most common pediatric chest injury after blunt trauma?

Answer

Pulmonary contusion

Young ribs are soft and pliable and fracture less commonly than in adults. Significant pulmonary injury can exist with little external evidence of injury in children.

Posted on 03/10/2009

What are the two classification schemes for the types of aortic dissection?

Answer

There are two main classifications schemes for aortic dissection:

The Debakey classification:

TYPE I: ascending aorta only
TYPE II: descending aorta only
TYPE III: ascending and descending aorta

The Sanford classification:

TYPE A: any involvement of the ascending aorta
TYPE B: only involving the descending aorta

The importance of the classification schemes is related to the treatment of aortic dissections. Any involvement of the ascending aorta is surgically managed. A dissection involving only the descending aorta should be medically managed. Medical management includes blood pressure control and pain management.

Clinical Pearl

Video Lecture

Visual Stim

Navigation

Clinical Pearls