Pulitzer Goes to...
Magic Finger(tips)
Potpourri
IPV
That Doesn't Go There
100
Continuous glucose monitoring is _____ effective than traditional self-monitoring practices.
not significantly more
A1C decreased only by a very modest 0.2% to 0.3% among no effect on blood pressure or lipids. Continuous monitors more likely to cause psychological stress.
100
Nail ______ is the first line treatment for enlarging or painful subungual hematomas.
Bonus: how?
Trephination
Making hole or fenestration in nail to relieve pressure. Can do this with heated paperclip or specific tool kit.
100
New AAP guidelines for prescribing opioids for acute pain in children recommend universal prescription of _____.
Naloxone
100
Most folks who experience IPV experience it before the age of ___.
25 yo
100
Foreign bodies of the throat should...
Present to the ED.
Emergent if airway compromise. Urgent consultation for removal of all others.
200
With IBS that has failed first line therapy should consider trial of ____.
Amitriptyline
Low dose, 10mg (titrate up to 30mg)
Can lead to meaningful improvement in symptoms (61% vs 45%; NNT = 7).
200
Name this injury!
Mallet finger
- loss of extensor function at the DIP; can be tendinous injury alone or bony with avulsion injury
- MOI: typically forceful flexion of DIP while finger is actively extended
- Workup: x-rays!
- Treatment: splinting in neutral or slight hyperextension for 6-8 weeks (bony mallets need longer, 8-12 wks)
- Indications for surgery: distal phalanx fracture involving more than one-third of the articular surface, volar subluxation of the distal phalanx, and failure of conservative treatment measures
200
Consider this kind of testing for kids with autism or kids with unexplained developmental delays.
- chromosomal microarray or exome sequence testing
- fragile x testing in males
200
Studies estimate that __% of women and __% of men have experienced and survived intimate partner violence.
47%, 59 million people
44% 52 million people
However this value is likely below actual due to underreporting
Most studies do not capture full gender spectrum, so data is expressed in a binary
200
Most patients with foreign bodies in their ear are present with _____.
Other symptoms can include:
No symptoms!
Otalgia, hypoacusis, pruritus, otorrhea, sensation of fullness. If irritating the vagus nerve: cough, hiccups
300
_____ and ______ have the best evidence for mono or combination therapy for management of diabetes.
SGLT2i; GLP1s.
Reduced all cause mortality, major cardiovascular events, CKD, and heart failure.
300
If someone comes in with a nailbed laceration you should obtain _____ to evaluate for _____ as they commonly co-occur.
x-rays; distal tuft fractures
300
These are the most common side effects to follow MMR or varicella vaccination.
- rash (RR = 2.05; 95% CI, 1.21–3.48; high-certainty evidence)
- seizure, typically w/in 1 week of MMR vaccination (RR = 2.45; 95% CI, 2.21–2.71; moderate-certainty evidence)
- increased risk of ITP, (RR= 4.21; 95% CI, 2.28–7.78; moderate-certainty evidence)
- no increased risk noted for ASD, IBD
300
Identify some risk factors for IPV
- age
- race or ethnicity (highest rates among Black, Native, multiracial populations)
- LGBTQIA+ identity (folks who are trans are 2-3x higher risk for IPV)
- rural
- immigrant or refugee status
300
These techniques are most commonly used for foreign body removal from the ear
irrigation (sterile saline solution or tap water) and instrumentation
Irrigation should not be used to remove batteries, absorbent materials such as vegetable matter, or fully occlusive objects. Tympanic membrane perforation and the presence of tympanostomy tubes are also contraindications to irrigation.
(A) From left to right: alligator forceps, right-angle hook, and nasal speculum. (B) From left to right: metal and plastic loop cerumen curettes. (C) From left to right: plastic and metal nasal specula.
400
GLP1s have demonstrated effectiveness in prevention of non-fatal MIs in people who have obesity and ______.
cardiovascular disease
Secondary prevention! NNT = 100. Has not been shown to impact cardiovascular mortality.
This effectiveness has not been studied in folks who have obesity but no CVD
*specifically do not have diabetes
400
Management for an uncomplicated distal interphalangeal joint dislocation.
- reduction to neutral position and splinting either in neutral position or 15-30 deg of flexsion (for dorsal dislocation)
- this should be preceded by xrays for good evaluation
- indications for surgical referral: closed reduction is unsuccessful, or if there are complicating factors such as large avulsion fractures or irreducible dislocations
400
New POEM recommends use of _____ for patients who have severe CAP.
- steroids!
Based on decreased hospital mortality (RR = 0.62; 95% CI, 0.45–0.85).
This includes patients with sepsis and ARDS.
**Recommend against high-dose, short-term steroids in patient with sepsis shock due to adverse effects.
400
These are some health conditions associated with IPV
- mental health: depression, posttraumatic stress disorder, anxiety, suicidal ideation and self-harm
- STDs
- T2DM, CVD, asthma, HTN, chronic pain
- homicide (increased risk while pregnant)
- low birth weight, abruption, PPROM,
400
These patients with foreign objects in their nose need to be referred to ENT for removal
- too posterior for direct visualization
- located above the inferior turbinates
- concern for button battery
- Penetrating foreign bodies, impacted objects with associated infection, paired disk magnets, and inability to cooperate with removal efforts
500
These side effects are important to consider when discussing the new monoclonal antibodies for Alzheimer's
Cerebral edema, hemorrhage
Minimal benefit noted, >2000$ annually
500
This is the colloquial term for a flexor digitorum profundus tendon (and/or bony) avulsion which occurs when the finger is forcibly extended while actively flexed.
Jersey Finger.
- dx: imaging (US, XR, +/- MRI)
- splint and referral to hand surgery
500
______ and GLP-1s are the most effective available meds for weight loss.
Phentermine-topiramate
- wellbutrin-naltrexone and orlistat also led to weight loss more than lifestyle change alone but side effects were more difficult to tolerate
500
USPSTF recommends screening for IPV in _____.
______ is supported in all patients.
Asymptomatic women of reproductive age
Anyone presenting with symptoms that could indicate IPV (PTSD, depression, anxiety, injuries, etc).
Universal education! This is a brief education, support, and referrals to services if the patient requests them. Shifts focus from disclosure to support.
500
This technique is safe and effective for removal of a nasal foreign body that is visible, nearly or totally occlusive.
Positive pressure
* The Parent's Kiss :0