![]() ![]() Scaphoid fractures commonly occur from a fall on outstretched hand (FOOSH). Scaphoid fractures may also cause pain with axial loading of the thumb on physical examination. The scaphoid is one of the carpal bones in the wrist. The snuffbox is the triangular depression at the base of the thumb on the dorsolateral aspect of the hand. If a question stem describes snuffbox tenderness on physical exam, you should think of a scaphoid fracture. Treatment is surgical along with IV fluids and electrolyte replacement if necessary.Ħ. Therefore, most question stems will usually have a male infant between 3-6 weeks old. Pyloric stenosis is more common in males and is typically seen before 12 weeks of age, although in some more rare cases can be seen from birth to 6 months. The “olive mass” is the enlarged/thickened pylorus. If the question stem describes feeling an “olive mass” on abdominal exam, then that is the clue for pyloric stenosis. Pyloric stenosis is thickening or narrowing of the pylorus, which makes it difficult for food to pass.Ī question stem involving an infant with projectile vomiting should make you consider pyloric stenosis as a possible diagnosis. The opening between the stomach and the duodenum (first part of the small intestine) is known as the pylorus. The buzzword for pyloric stenosis is palpable olive mass. Splinter Hemorrhage = Bacterial Endocarditisĥ. Microbiological evidence not meeting major criteria above Predisposing heart condition or IV drug use Obtain 3 sets of blood cultures and initiate IV antibiotics if there is clinical concern for endocarditis, and make sure to cover for MRSA if there is a history of IV drug use or other risk factors.ĭiagnostic work up typically involves an echocardiogram to assess for cardiac vegetations.ĭukes criteria can be used to help diagnose endocarditis.Įvidence of endocarditis on echocardiogram The tricuspid valve is most commonly affected by bacterial endocarditis caused by IV drug use. ![]() Other symptoms or findings of bacterial endocarditis include chest pain, shortness of breath, heart murmur, Osler’s nodes, Janeway lesions, and Roth spots. There are several conditions that can cause splinter hemorrhages, but when you see it on an exam it is likely a buzzword for bacterial endocarditis (infective endocarditis).īacterial endocarditis is an infection of the inner lining of the heart.Īlways consider endocarditis in a patient who has a fever and a history of IV drug use, or who has other risk factors such as prosthetic valve, immunodeficiency, or structural heart disease. Splinter hemorrhages typically run vertically, and they are caused by hemorrhages from damage to the capillaries underneath the nails. Splinter hemorrhages are thin, longitudinal reddish-brown lines underneath the nails (typically fingernails) that look like wood splinters. Splinter Hemorrhage = Bacterial Endocarditis ![]()
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