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In-Training Exam High Yield Topics GASTROINTESTINAL

In-Training Exam High Yield Topics GASTROINTESTINAL. Emergency Medicine Foundations Curriculum. In-training Exam (ITE) Content:. Written to level of EM3 Predicts performance on EM Boards 225 MC questions Given 4.5 hrs to take +/- 25 are visual stimuli – pictures/ ekg/xrays

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In-Training Exam High Yield Topics GASTROINTESTINAL

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  1. In-Training ExamHigh Yield Topics GASTROINTESTINAL Emergency Medicine Foundations Curriculum

  2. In-training Exam (ITE) Content: • Written to level of EM3 • Predicts performance on EM Boards • 225 MC questions • Given 4.5 hrs to take • +/- 25 are visual stimuli – pictures/ekg/xrays • Highest yield topics • Cardiovascular ~ 10% • Trauma ~ 10% • Abd/GI ~ 8% • Thoracic/Respiratory ~ 8% • Procedures/Skills ~8% • Note that Geriatrics makes up at least 6% of these and Pediatrics at least 8%

  3. Foundations Challenge Overview • Rapid Review of High-Yield Test Topics • Visual Diagnosis • Clinical Concepts • Rapid Fire • Work in 2-4 different teams • Answer challenge questions for points • Point value per challenge varies by difficulty • Win test prep and pride

  4. Foundations Challenge Rules • Create a Team Name • Best Team Name starts the Challenge (as arbitrarily determined by your Instructor) • Your team must answer the entire question correctly to win points • If you team answers incorrectly, the Challenge Question points can be stolen by the next team • If they answer correctly, they get your points AND a chance to answer the next question • If they answer incorrectly, the turn passes again to the next team in line

  5. GASTROINTESTINAL

  6. Foundations Challenge Visual Diagnosis 2 pts Diarrhea Diagnosis?? Treatment??

  7. Foundations Challenge Visual Diagnosis 2 pts Dx: Giardia Tx: Metronidazole Diarrhea

  8. Foundations Challenge Visual Diagnosis 2 pts Abdominal Pain, Stable Vitals Diagnosis?? Treatment??

  9. Foundations Challenge Visual Diagnosis 2 pts Sigmoid Volvulus Decompression (sigmoidoscopy) Abdominal Pain, Stable Vitals

  10. Volvulus Foundations Challenge Knowledge Bomb • Sigmoid Volvulus • Elderly, immobilized, constipation • RUQ Loop • Endoscopic decompression if stable, surgery if unstable • CecalVolvulus • Younger active patient • LUQ Loop • Always require surgery (high rate of necrosis )

  11. Foundations Challenge Visual Diagnosis 1pt Vomiting, Chest Pain Diagnosis??

  12. Foundations Challenge Visual Diagnosis 1pt Vomiting, Chest Pain Boerhaave syndrome

  13. Foundations Challenge Visual Diagnosis 1pt Consult GI or ENT?

  14. Foundations Challenge Visual Diagnosis 1pt GI: coin in esophagus will align in coronal plane

  15. Esophageal Foreign Bodies Foundations Challenge Knowledge Bomb The Problem • Kids swallow weird things; Adults get food stuck The Clues • Vomiting, gagging, choking, neck or chest pain, dysphagia, odynophagia • XR shows radiopaque FBs; consider CT or endoscopy if high clinical suspicion but XR negative The Solution • High-risk FBs (button battery, sharp objects) require emergent removal; others ok for 24hr trial of passage • Food impaction treated with Glucagon 1mg IV vs. soda vs. endoscopy • ALL EFBs require opt GI followup to r/o structural pathology

  16. “Nothing is scarier than attempting your first fart after a bout of diarrhea.”- Unknown

  17. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts

  18. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts

  19. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts

  20. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts

  21. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts

  22. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts

  23. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts

  24. DiarRheaClinical Syndromes Foundations Challenge Clinical Concepts 3 pts *Usually non-cholera in the US

  25. Bacterial Diarrhea: ENTEROTOXIN-MEDIATED Foundations Challenge Knowledge Bomb

  26. Bacterial Diarrhea: INVASIVE Foundations Challenge Knowledge Bomb

  27. Foundations Challenge Clinical Concepts 2 pts What2 diagnostic tests are consistent with acute Hep B infection?

  28. Foundations Challenge Clinical Concepts 2 pts What diagnostic tests are consistent with acute Hep B infection? HBsAgANDIgM anti-core Ab

  29. Viral Hepatitis Foundations Challenge Knowledge Bomb • Hepatitis A • Gastro + jaundice, fecal-oral transmission • Anti-HAV IgM (acute), IgG (prior) • Hepatitis B • Blood/body fluid transmission, 10% have chronic disease • HBsAg (active infection), HBcAbIgM (early/active infection), anti-HBs (immunity) • Hepatitis C • Body/blood transmission, ~90% develop chronic infection, 10-20% develop chronic liver disease • Anti-HCV = acute or past infection • Hepatitis D • Co- or superinfection with HBV • Hepatitis E • Fecal-oral transmission, fulminant liver failure during pregnancy with high mortality

  30. Crohn’s Disease or Ulcerative Colitis? Foundations Challenge Clinical Concepts 1pt Skip Lesions Continuous Disease Rectum & Colon Any Part of GI Tract Fistulas & Stricture

  31. Crohn’s Disease Foundations Challenge Clinical Concepts 1pt Ulcerative Colitis Skip Lesions Continuous Disease Any Part of GI Tract Rectum & Colon Fistulas & Stricture

  32. Caustic Ingestion: which is worse? Foundations Challenge RAPID FIRE 3 pts Acid or Alkali??? SBP: What makes paracentesis fluid positive? WBC > ??? OR Neutrophils > ??? Afib + Severe Abd Pain Diagnosis???

  33. Foundations Challenge RAPID FIRE 3 pts Caustic Ingestion: which is worse? Alkali SBP: What makes paracentesis fluid positive? WBC > 500 OR Neutrophils > 250 Afib + Severe Abd Pain Mesenteric ischemia

  34. Cholangitis: (Charcot’s Triad)Fever + RUQ pain + Jaundice Foundations Challenge RAPID FIRE 3 pts What 2 additional symptoms are included in Reynold’s Pentad??? Most common cause of SBO? ??? AAA repair + Massive GI Bleed Diagnosis???

  35. Foundations Challenge RAPID FIRE 3 pts Cholangitis: (Charcot’s Triad)Fever + RUQ pain + Jaundice AMS Hypotension Most common cause of SBO? Adhesions AAA repair + Massive GI Bleed Aortoenteric fistula

  36. Good Luck!!! www.emergencymedicinefoundations.com

  37. References Foundations Teaching Content: Dr. Kristen Grabow Moore, MD, MEd Assistant Professor, Emory University Dr. Andrew Ketterer, MD, MA Medical Education Fellow, Beth Israel Deaconess References: • Life in the Fast Lane • HippoEM Board Review • Rivers Written Board Review • Medscapeemedicine • Northwestern EM Chief Residents

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