1. In-Training Exam High Yield Topics grab bag
ITE High Yield Topics Presentations:
This is one of multiple presentations included in our revised 2018 EMF ITE resources. Presentation content is divided by system and includes the highest-yield (highest % on the test) systems: Cardiovascular, Trauma, Gastrointestinal, Pediatrics, Pulmonary, Toxicology, ID and Neurology. Each system presentation has three different sections: Visual Diagnosis, Clinical Concepts and Rapid Fire. Scattered throughout are “Knowledge Bomb” slides that provide a more in-depth summary of certain high-yield topics.
Timing:
Each presentation in this series is of variable length, thus the time required to lead instruction will also be variable. In general, the expected time range for presentations is minutes. The specific time you’ll need will depend not only on presentation length, but also how much embedded conversation or focused review (“knowledge bomb” content) you intend, in addition to the familiarity of your residents with this content.
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
Running the Meeting:
Start by dividing learners into 2-4 teams and direct them to separate areas of the room
You should assign a learner or instructor to serve as scorekeeper and ask for updates on the score when you switch topics
Provide and guide reasonable time limits to answer challenge questions
Monitor time closely as you move through the review to keep pace with planned content
If you have the time/energy, you may consider giving a prize/reward for the winning team

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
You may choose to modify the point assignment system (all or nothing vs. partial credit)

5. Grab bag

6. Itchy Rash + Linear Burrows
Foundations Challenge
RAPID FIRE
3 pts
Itchy Rash + Linear Burrows
Diagnosis???
Erythema Multiforme
Most Common Cause???
Scabies
HSV
Disseminated Gonorrhea
Gunmetal gray pustules on palms
Diagnosis???

7. 3 pts Itchy Rash + Linear Burrows Erythema Multiforme
Foundations Challenge
RAPID FIRE
3 pts
Itchy Rash + Linear Burrows
Scabies
Erythema Multiforme
HSV
Scabies- linear burrows, itchy rash to hand/feet/groin, Tx permethrin (NOT lindane if peds/pregnant, causes seizure);
Most common cause of erythema multiforme
HSV
Gunmetal gray pustules on palms
Disseminated Gonorrhea
Gunmetal Gray Pustules on Palms
Disseminated Gonorrhea

8. Finding NO difference when one exists
Foundations Challenge
RAPID FIRE
3 pts
Finding NO difference when one exists
Error Type???
Finding a difference when one does NOT exist
Error Type???
Type II error
Type I error
High sensitivity
Best for ruling out disease
High Sensitivity or High Specificity???

9. 3 pts Finding NO difference when one exists
Foundations Challenge
RAPID FIRE
3 pts
Finding NO difference when one exists
Type II
Finding a difference when one does not exist
Type I
Type II error
Finding no difference when one exists
Type I error
Finding a tx effect when one does not exist
What type of test (high sensitivity or high specificity) is best for Screening/Ruling Out disease verses Confirming disease?
High sensitivity tests are best for Screening/Ruling Out disease (low False Neg rate);
High specificity tests are best for Confirming disease (low False Pos rate)
Best for ruling out disease
High Sensitivity

10. 3 pts Strawberry Cervix Pre-eclampsia < 24wks
Foundations Challenge
RAPID FIRE
3 pts
Strawberry Cervix
Diagnosis???
Pre-eclampsia < 24wks
Diagnosis???
Trichomonas
Molar pregnancy
Ovarian torsion
Abdominal Pain After Sex
Diagnosis???

11. 3 pts Strawberry Cervix Pre-eclampsia < 24wks
Foundations Challenge
RAPID FIRE
3 pts
Strawberry Cervix
Trichomonas
Pre-eclampsia < 24wks
Molar Pregnancy
Abdominal Pain After Sex
Ovarian Torsion

12. Discriminatory Zone for TVUS
Foundations Challenge
RAPID FIRE
3 pts
Discriminatory Zone for TVUS
bHCG???
PID and RUQ/Shoulder Pain
Diagnosis???
1500
Fitz-Hugh-Curtis Syndrome
Uterine Atony
Most Common Cause of Postpartum Hemorrhage (<24hr)
???

13. 3 pts Discriminatory Zone for TVUS PID and RUQ/Shoulder Pain
Foundations Challenge
RAPID FIRE
3 pts
Discriminatory Zone for TVUS
1500
PID and RUQ/Shoulder Pain
Fitz-Hugh-Curtis Syndrome
Discriminatory zone for TVUS (bhcg)
1500
PID and RUQ shoulder pain
Fitz-Hugh-Curtis Syndrome (perihepatitis)-
infection to perihepatic space causing RUQ or R shoulder pain; may see "violin-string" adhesions, usually normal LFTs
What are the most common causes of postpartum hemorrhage based on timing of presentation?
Early (<24hr)- **uterine atony (MC), lacerations, retained POC;
Late (>24hr)- retained products, lacerations
Atony- massage, oxytocin, IVF;
Lacs- surgical repair;
Retained products- dx US, surgical removal;
all transfuse as needed
Most Common Cause of Postpartum Hemorrhage (<24hr)
Uterine Atony

14. 3 pts Pizza Pie Fundus Corneal Dendrites
Foundations Challenge
RAPID FIRE
3 pts
Pizza Pie Fundus
Diagnosis???
Corneal Dendrites
Diagnosis???
CMV Retinitis
HSV Keratitis
Thyroid Storm
Tachycardia Out of Proportion to Fever
Diagnosis???

15. 3 pts Pizza Pie Fundus Corneal Dendrites
Foundations Challenge
RAPID FIRE
3 pts
Pizza Pie Fundus
CMV Retinitis
Corneal Dendrites
HSV Keratitis
Pizza pie on fundus
CMV retinitis
Corneal dendrites -> HSV Keratitis
Tachycardia out of proportion to fever
Thyroid storm
Tx for thyroid storm? 1) Propranolol 2) PTU/methimaxole 3) Iodine (1 hour after #2)
Tachycardia Out of Proportion to Fever
Thyroid Storm

16. Alcohol + AMS + Ataxia + Nystagmus
Foundations Challenge
RAPID FIRE
3 pts
Alcohol + AMS + Ataxia + Nystagmus
Diagnosis???
Stingray Wound
How do you deactivate toxin???
Wernicke's Encephalopathy
Hot Water Immersion
Hypoglycemia
Beta-blocker OD
Hyperglycemia OR Hypoglycemia

17. 3 pts Alcohol + AMS + Ataxia + Nystagmus Stingray Wound
Foundations Challenge
RAPID FIRE
3 pts
Alcohol + AMS + Ataxia + Nystagmus
Wernicke Encephalopathy
Stingray Wound
Hot Water Immersion
Alcoholic with AMS, ataxia, nystagmus
Wernicke's Encephalopathy 2/2 Thiamine (B1) deficiency;
Tx Thiamine 500 mg IV, improvement in hours
What is the appropriate Tx of marine vertebrate wounds (eg stingrays)? (Stingrays, Lionfish, stonefish)
wound care, antibiotics (keflex/doxy), r/o foreign body,
**hot water immersion to deactivate heat labile toxin, do NOT close wounds
Beta-blocker OD: hypo- or hyper-glycemia?
Hypoglycemia
Beta-blocker OD
Hypoglycemia

18. Good Luck!!!

19. References Foundations Teaching Content: References:
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
Medscape emedicine
Northwestern EM Chief Residents
Authors: Dr. Kristen Grabow Moore, Emory University and Dr. Andrew Ketterer, Beth Israel Deaconess Medical Center
Content Revision Winter 2018
References:
Life in the Fast Lane
HippoEM Board Review
Rivers Written Board Review
Medscape emedicine
Northwestern EM Chief Residents