--- title: February 13, 2025 Customer Newsletter description: "EM case and exam tips: cliff‑fall trauma case, question analysis, and links to EM board‑review courses." image: https://challengercme.com/hs-fs/hubfs/res%20nl%20dec.png?width=1200&upscale=true&name=res%20nl%20dec.png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/february-13-2025-customer-newsletter-0-0#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) # February 13, 2025 Customer Newsletter EM case and exam tips: cliff‑fall trauma case, question analysis, and links to EM board‑review courses. 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[BROWSE COURSES](https://fuse.challengercme.com/store) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/february-13-2025-customer-newsletter-0-0&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/february-13-2025-customer-newsletter-0-0&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/february-13-2025-customer-newsletter-0-0&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/february-13-2025-customer-newsletter-0-0&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![December 12, 2024 Customer Newsletter](https://challengercme.com/hs-fs/hubfs/res%20nl%20dec.png?width=1200&upscale=true&name=res%20nl%20dec.png) - Working More and Getting Less  - Ready for the ABFM Boards? - Direct-to-Consumer Advertising - PEMQBook Live Board Review - AMA Meets Need for New CPT Codes - QUIZ - Test Your Knowledge ## ![divider winter](https://challengercme.com/hs-fs/hubfs/divider%20winter.webp?width=800&height=56&name=divider%20winter.webp)Physicians Working More but Generating Less Revenue   OK, we’re sorry, but this entire article reads like some sort of horrible dystopian fiction. The focus—being a CFO-type article—is on physicians working 8% more, and some getting paid 8% more (a rather uneven break), with fewer staff. The conclusion drawn from the fact that you can’t keep pushing physicians to generate more and more RVUs and expand margins is that the fee-for-service model has failed. Therefore, we have to stop paying physicians fee-for-service and create an even more complex payment system. Excuse us while we freak out. 🤢 [Physicians Working More but Generating Less Revenue](https://www.beckershospitalreview.com/finance/physicians-working-more-but-generating-less-revenue.html) - Becker’s Hospital CFO Report | ## ![divider winter2](https://challengercme.com/hs-fs/hubfs/divider%20winter2.webp?width=796&height=56&name=divider%20winter2.webp) [![abfm board exam](https://challengercme.com/hs-fs/hubfs/abfm%20nl%20ad.png?width=719&height=240&name=abfm%20nl%20ad.png)](https://challengercme.com/family-medicine-exam-review-cme-course?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--h4_K1xqbWHyPlvzMLzYDn53lckrCbWiKVffpJ9CeHzLjpVHUH4fF498uf08CX73KSHftw) ## ![divider winter5](https://challengercme.com/hs-fs/hubfs/divider%20winter5.webp?upscale=true&width=1120&height=78&name=divider%20winter5.webp) Direct-to-Consumer Advertising Distorts Prescription Drugs’ Benefits and Costs - AAFP Prescription advertising is about to become a political football in the United States—Super Bowl reference intended. In this case, the AAFP is highlighting the actual cost ($288,000) of a drug advertised during the Super Bowl, compared to the promoted price (as low as $5 per dose). This pricing discrepancy is made possible through the deductible rebate card program. It’s not an outright lie—the patient’s out-of-pocket cost after the rebate is indeed $0 to $5 per dose, but only if the insurer covers it. The negotiated rate with Medicare, however, is a different story. As the AAFP points out, this is not a drug a physician would typically prescribe today for even serious plaque psoriasis. While it is an effective medication, it is generally reserved for patients who have not responded to more affordable alternatives or have encountered issues with anti-TNF therapies. Direct-to-consumer (DTC) prescription advertising first appeared in the 1980s but didn’t gain traction until 1997, when the FDA clarified how risk and benefit information should be presented—often alongside glowing, happy images of elderly patients. Given some of the more extreme examples and the rise of DTC telehealth from the same pharmaceutical companies, pushback is growing. [Direct-to-Consumer Advertising Distorts Prescription Drugs’ Benefits and Costs](https://www.aafp.org/pubs/afp/afp-community-blog/entry/direct-to-consumer-advertising-distorts-prescription-drugs-benefits-and-costs.html?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz--FNjtUHGu4rCEmoJCFmu7kUjwPo1WVa5O43qRPdOiabKoe5Hhsgr63_n5c4IOCXcvX2NL8) - AAFP ![divider winter4](https://challengercme.com/hs-fs/hubfs/divider%20winter4.webp?upscale=true&upscale=true&width=1120&height=78&name=divider%20winter4.webp) [![pemqbook live course](https://challengercme.com/hs-fs/hubfs/pemqbook%20nl%20ad.png?width=792&height=792&name=pemqbook%20nl%20ad.png)](https://challengercme.com/pediatric-emergency-medicine-live-course-3rd-edition?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz-9bpibep4PeDrrd2Fu0xzbjCPN38jWgkzZAA-BlXLb4n_m3NeRHAfrCdlFnhJGXqT0_S02h) ## [![divider winter 3](https://challengercme.com/hs-fs/hubfs/divider%20winter%203.webp?upscale=true&upscale=true&width=1120&height=78&name=divider%20winter%203.webp)](https://challengercme.com/med-challenger-free-trial-landing-page?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz-9fStEIRGQhQAKWVjrvYOiCSzuM2UYwuRDKX9BT4S9to4I9g4Svj8pqwingO68SHB24kgHc)How the AMA Meets Need for New Telehealth CPT Codes \| American Medical Association Telehealth is safe—for now. It’s been extended until at least April, or whenever the latest continuing resolution runs out. (We’re still no closer to actual legislation defining telehealth services and reimbursement.) In the meantime, CMS has expanded coverage for additional reimbursable items and is maintaining the suspension of frequency limitations. They’ve also officially defined phone calls under telehealth: "Interactive telecommunication system” will now permanently include two-way, real-time audio-only communication technology for any Medicare telehealth service furnished to a beneficiary…” Basically, for when you just can’t get people to hop on a Zoom call. 😄 Oh, and expect new CPT codes in the EHR soon! [How the AMA Meets Need for New Telehealth CPT Codes](https://www.ama-assn.org/practice-management/cpt/how-ama-meets-need-new-telehealth-cpt-codes) - AMA ![res nl dec div](https://challengercme.com/hs-fs/hubfs/res%20nl%20dec%20div.png?upscale=true&upscale=true&width=1120&height=78&name=res%20nl%20dec%20div.png)  [![EM board quick quiz question](https://challengercme.com/hs-fs/hubfs/quiz%20ad%20NL.png?width=940&height=788&name=quiz%20ad%20NL.png)](https://challengercme.com/blog/a-34-year-old-man-presents-after-having-fallen-from-a-cliff-while-rappelling?utm_campaign=Blog%20Subscribe&utm_content=324680830&utm_medium=social&utm_source=facebook&hss_channel=fbp-122666784576)QUIZ QUESTION ## A 34-year-old man presents after having fallen from a cliff while rappelling A 34-year-old man with no prior medical history presents to you after having fallen from a cliff while rappelling 7 hours ago. He underwent a complicated, prolonged extraction from a ravine, and he is complaining of 10/10 lower back pain. You note that the groin area of his pants is wet and he has no rectal tone on examination. The lateral plain radiograph of his lumbar spine is shown below. Regarding additional emergent studies of the lower back, which of the following choices is true? - Emergent electromyography differentiates between specific nerve root compression and an upper motor neuron lesion, which affects management. - MRI or a CT scan should be performed on an emergent basis for cauda equina syndrome. - No further studies should be performed – the diagnosis is clear. - Bone scans are only indicated on an emergent basis if there is a history of cancer or advanced age in addition to bone trauma. [![CLICK FOR ANSW](https://challengercme.com/hs-fs/hubfs/CLICK%20FOR%20ANSW.jpg?upscale=true&upscale=true&width=333&height=84&name=CLICK%20FOR%20ANSW.jpg)](https://challengercme.com/blog/a-34-year-old-man-presents-after-having-fallen-from-a-cliff-while-rappelling?utm_campaign=Blog%20Subscribe&utm_content=324680830&utm_medium=social&utm_source=facebook&hss_channel=fbp-122666784576) | | --- | [ Subscribe to Our Blog & Save 15% ](https://challengercme.com/blog) ## Similar posts emergency medicine ### [25-year-old man presents to you with an injury to his left foot](https://challengercme.com/blog/25-year-old-man-presents-to-you-with-an-injury-to-his-left-foot) It's Wound Management Quiz Time with Med-Challenger! EM case: contaminated plantar laceration — high‑yield wound management quiz, Emergency Medicine... Med-Challenger Dec 12, 2024 emergency medicine ### [Pediatrics case: 14‑y girl with earlobe dermatitis](https://challengercme.com/blog/a-14-year-old-girl-with-dermatitis-on-her-earlobe) Pediatrics case quiz: 14‑y girl with earlobe dermatitis — exam‑style Q&A and concise rationale for Peds/EM board prep. Med-Challenger Feb 20, 2025 Product News ### [Challenger Feature - AI Content Enhancement - Case Study Analysis](https://challengercme.com/blog/articles/2024/03/challenger-feature-ai-content-enhancement-case-study-analysis) Of the many enhancements, the Case Study analysis feature stands out for its ability to create rich, engaging scenarios that reflect real-world... Med-Challenger Mar 18, 2024 ## Stay informed. ### Subscribe to our [Medical Education Blog](https://challengercme.com/blog)  Stay informed of new medical education content, certification requirements and deadlines, case-based CME quizzes, and special offers. 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "emergency medicine", "cauda equina syndrome", "lumbar spine trauma", "telehealth CPT codes", "direct-to-consumer prescription advertising", "physician revenue and RVUs", "ABFM Boards", "exam preparation", "board review (PEMQBook)" ], "articleSection" : "Medical Education Newsletter", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2025-12-04T16:37:41.968Z", "datePublished" : "2025-02-13T19:51:10.000Z", "description" : "EM case and exam tips: cliff‑fall trauma case, question analysis, and links to EM board‑review courses.", "headline" : "February 13, 2025 Customer Newsletter", "image" : [ { "@type" : "ImageObject", "description" : "Med-challenger Newsletter Feb 2025" }, { "@type" : "ImageObject", "description" : "EM board quick quiz question" }, { "@type" : "ImageObject", "description" : "A 34-year-old man presents after having fallen from a cliff while rappelling" } ], "inLanguage" : "en-US", "keywords" : [ "Emergency Medicine", "cliff fall", "rappelling", "lumbar spine", "no rectal tone", "cauda equina", "MRI", "CT", "telehealth", "CPT codes", "direct-to-consumer advertising", "prescription drug pricing", "physician revenue", "RVU", "ABFM Boards", "board review", "PEMQBook" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/february-13-2025-customer-newsletter-0-0", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "MRI or CT scan should be performed on an emergent basis for suspected cauda equina syndrome. The combination of severe low back pain, urinary/groin findings, and absence of rectal tone indicates possible cauda equina compression and warrants urgent cross-sectional imaging; electromyography and bone scans are not appropriate emergent tests in this scenario." }, "name" : "Emergent imaging for suspected cauda equina in a patient after a cliff fall", "text" : "A 34-year-old man with no prior medical history presents after falling from a cliff while rappelling 7 hours ago. He underwent a complicated, prolonged extraction and now complains of 10/10 lower back pain. The groin area of his pants is wet and he has no rectal tone on examination. Regarding additional emergent studies of the lower back, which of the following choices is true?" } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "MRI or CT scan should be performed emergently for suspected cauda equina syndrome, given signs such as severe back pain, urinary/groin findings, and loss of rectal tone." }, "name" : "Which imaging study should be obtained emergently for suspected cauda equina?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Absence of rectal tone combined with wetness in the groin area and severe low back pain suggests possible cauda equina compression that needs urgent evaluation." }, "name" : "What clinical finding in the newsletter case suggests possible cauda equina syndrome?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "CMS will include two-way, real-time audio-only communication technology as part of the definition of an interactive telecommunication system for Medicare telehealth services, per the newsletter summary." }, "name" : "How did CMS define phone calls in relation to Medicare telehealth in the newsletter summary?" }, "position" : 3 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "The newsletter notes that advertised out-of-pocket prices (often via deductible rebate cards) can be much lower for patients than the negotiated prices with Medicare; the example contrasted an advertised per-dose price with a much higher overall drug cost." }, "name" : "What pricing discrepancy related to direct-to-consumer drug advertising does the newsletter highlight?" }, "position" : 4 } ], "name" : "Practice Questions", "numberOfItems" : 4 } ```