Change your thoughts and you change your world. -Norman Vincent Peale Welcome back to Episode 21! We are all over the place this week, tackling topics from orthopedics to electrolyte abnormalities. Thanks to our listeners for the excellent feedback. Keep it coming to [email protected]. Let’s get started with a quick neurology rapid review from prior episodes! * Treatment for a radial nerve palsy is supportive with a wrist splint, and the condition is typically self-limited. * VP shunt obstruction occurs proximally more often than it occurs distally. Proximal VP shunt obstruction occurs due to choroid plexus obstruction or increased protein within the CSF. Distal VP shunt obstruction occurs due to abdominal pseudocyst formation, which typically presents with abdominal pain due to the large size of the cyst. * Lyme disease is the most common cause of a bilateral Bell’s Palsy.  Remember that a peripheral facial nerve palsy can be distinguished from a central one by involvement of the forehead. Now onto this week’s podcast Question 1 A patient presents to you as a transfer from an outside facility with the radiograph seen above. Which of the following exams will evaluate for the most commonly associated nerve injury in this type of fracture? A. Ability to make a “thumbs up” sign B. Ability to make an “OK” sign C. Sensation to the index finger D. Sensation to the little finger Teaching Image Question 2 Which of the following is a common cause of hypomagnesemia? A. Antacid use B. Hypoparathyroidism C. Hypothyroidism D. Malnutrition Teaching Image Question 3 A 24-year-old man is brought to the ED after sustaining a stab wound to the right side of his chest. He is diagnosed with a hemothorax and a 38-French chest tube is placed in the resuscitation room. Which of the following best predicts the need for urgent thoracotomy? A. Initial chest tube output of greater than 1,000 mL of blood B. Initial chest tube output of greater than 10 mL/kg of blood C. Persistent output of greater than 100 mL of blood per hour for the first 3 hours following chest tube placement D. Persistent output of greater than 7 mL of blood per kilogram per hour following chest tube placement Teaching Image Question 4 A 45-year old woman with a history of hypertension and atrial fibrillation presents with a complaint of sudden onset vision loss in her right eye that occurred 10 minutes prior to arrival in the emergency department. She denies associated pain or trauma to the eye. Visual acuity is 20/20 at baseline, however she can now only count fingers on the right. What is the appropriate next step? A. Arrange for 24-hour follow-up with ophthalmology B. Digitally massage the globe C. Obtain a CT scan of the head without contrast D. Perform an anterior chamber paracentesis Teaching Image Question 5      A 19-year-old man presents to the ED after jamming his finger while playing basketball. On exam, he has swelling and tenderness to the proximal interphalangeal joint and pain with proximal interphalangeal joint extension.