which of the following is an indication for admission in patients with hepatitis ?

What is the most common cause of death in patients with congestive heart failure?

This 46-year-old gardener presented to a remote clinic in a Guatemalan village. He complained of nodular, erythematous lesions on his right upper extremity. The initial lesion on his distal arm eventually ulcerated, and other lesions have been draining nonpu-rulent material. The patient is otherwise without complaints and specifically denies nausea, vomiting, fevers, weight loss or diarrhea. On examination, he appears generally well, with the exception of the impressive lesions on his right upper extremity, seen in the pictures. What is the most likely cause for these lesions?

Aspirin toxicity causes which of the following acid base disturbances?

A 6-year-old girl with no prior medical history presents for evaluation of rash and shortness of breath after being stung by a bee. On examination, she is in mild distress with tachycardia and tachypnea. On exam, she has wheezing on lung auscultation. Her skin exam also shows diffuse erythema and hives. There is no evidence of stridor, and she is protecting her airway. What is the correct dose of epinéphrine if given intramuscularly?

A 43-year-old female presents to the emergency department with a concern that she is having a stroke. She notes left facial weakness, pain in her left ear, and that whenever she drinks water it spills out the left side of her mouth. The symptoms have progressed over the past 24 hours. The photograph demonstrates the patient when she is asked to "smile and look up." In the patient with this condition, which of the following medical treatments should be considered?:

A 56-year-old woman presents with a hard painless nodule located by her right jaw that she first noticed this evening. She is unsure how long it has been there. It is not painful and she denies any recent infections. Her vital signs are within normal limits. On physical exam, she has a fixed, palpable, non-tender, 2 cm nodule located in her right submandibular area. No erythema or fluc-tuance is appreciable. What is the next step in evaluation of this nodule?

Which of the following is true for cryptococcal meningoencephalitis?

Which of the following is true regarding diaphragmatic hernias?

A patient slips and cut himself on a metal fence post two weeks later the wound is low to heal. He has difficulty swallowing and muscle spasms. Tetanus is suspected what is the preferred antibiotic to be initiated ?

Case presentation: A 47-year-old male without a past medical history presented to the emergency department with chest pain. The pain had occurred earlier in the day and resolved spontaneously; then it had recurred approximately 90 minutes prior to arrival. The physical examination revealed an anxious-appearing adult male with significant diaphoresis but was otherwise unremarkable. 12-lead ECG is shown here. Question: The use of the ECG can aid in risk prognostication in patients with acute coronary syndrome (ACS). Indicate which statement below is INCORRECT regarding risk assessment with respect to the ECG in the patient with ACS:

A 57-year-old male with a history of hypertension, diabetes melli-tus, and chronic kidney disease presents to the emergency department with a complaint of pain in his first metatarsophalangeal (MTP) joint. He reports that it started several days after one of his medications was changed. He has had episodes in the past and has been on allopurinol ever since. Which of the following statements about this diagnosis is true?

All of the following are true regarding the diagnosis of ectopic pregnancy except:

which of the following is a sign of an upper motor neuron lesion?

35. Which of the following parasitic infections is an important cause of bladder cancer worldwide?

A 35-year-old G4P3 female at 29 weeks gestation presents to your ED after being in a motor vehicle collision. She was a restrained driver when she was struck from the side while traveling 45 mph. Her airbag deployed and her windshield shattered. Upon arrival to your ED, her vital signs are HR of 95, BP of 70/40, RR of 24, Sp02 of 94% on room air, and fetal heart tones are 95. You order a trauma panel including a blood gas. What venous blood gas findings would worry you for fetal demise?

A staff member in your emergency department is exposed to secretions from a patient known to be human immunodeficiency virus (HIV) positive. Which of these exposures is the highest risk?

Which of the following is true regarding Osborne waves in hypothermia?

Case presentation: A 21-year-old man was lying naked in a sleeping bag in his tent on the Appalachian Trail in Virginia when a massive thunderstorm entered the region. He was "jolted" following a nearby lightning strike and had immediate pain in his shoulder. He presented to the emergency department with the skin findings noted in the photograph here. Question: What is the name of this skin finding that is pathognomonic for a lightning strike?

Which of the following potential bioterrorism agents is considered MOST transmissible from person-to-person?

A 63-year-old male with a history of neck cancer and subsequent tracheostomy presents with a complaint of facial "fullness" that rapidly developed over the previous 24 hours. For the past week, he has noted mild facial swelling in the morning, but it has rapidly resolved as the day progressed. He denies trauma, fever, or dental discomfort. He is taking no new medications and is not on any angiotensin-converting enzyme inhibitors. His facial examination is pictured. What is the most likely clinical diagnosis?

A 47-year-old female presents to the emergency department with a complaint of acute retrob-ulbar pain and left lid droop. She also states that when she holds her eyelid open, she has double vision. Her past medical and ocular history is negative for hypertension and diabetes. She takes no medications. Physical examination reveals a complete ptosis of the left upper lid as noted in the photograph. Manually lifting the eyelid reveals the left eye with an outward deviation. The evaluation pictured here of the extraocular muscles shows a marked reduction in adduction and elevation, and depression of the left globe. Visual acuity is 20/20 in each eye. Pupillary testing shows marked anisocoria, with the right pupil 3mm and the left pupil 8mm. The left pupil does not constrict to light stimulation. The remaining ocular and neurologic examination is normal. What is the most likely cause of this patient’s physical examination findings?

Two men get into a fight over which pony they think is the cutest and one of them gets punched in the face. He presents with a sunken eye and decreased sensation on his upper cheek. While checking extraocular movements, you ask him to look up and he reports double vision. Which of the following muscles is most likely involved?

A 28-year-old college student presents to the emergency department after a tick bite. One week prior, he and a few friends hiked a portion of the Appalachian Trail. This morning, he found a tick attached to his left arm. Upon arrival, you note an engorged Ixo-des tick. Which of the following statements is true regarding treatment for this patient?

Which of the following is NOT a common pulmonary complication seen in acute pancreatitis?

A 7-year-old male was exposed to anthrax. Which of the following antibiotics is used for prophylaxis?

A 50 year old woman presents with fever, chills, nausea and right sided CVA tenderness. Vitals are as follows temperature: 103F, BP 90/70 HR 120. IV. Fluids and antibiotics are started. CT scan shows a right sided, proximal urethral stone with Hydro nephrosis. what is the most appropriate next step in management?

A 6-year-old male with sickle cell disease presents to the emergency department with one month of an aching pain in his right hip and groin. His parents do not recall any specific trauma, but admit that he tends to be a "rough and tumble kid," especially with the family dog: On exam, the patient's right hip has decreased range of motion with internal rotation and abduction. Which one of the following would you NOT expect to see on an x-ray of the patient's hip?

which of the following statements is true regarding Gammahydroxybutraye (GHB) intoxication?

What is the most common cause of acute chest syndrome in patients with sickle cell disease?

A 48-year-old female presents to the emergency department with the chief complaint: "My eyes are yellow!" She denies other clinical symptoms. Her physical examination is remarkable only for scleral icterus and jaundice (illustrated). No abdominal tenderness or hepatomegaly is detected. Which of the following statements is true?

A 53-year-old healthy woman presents with several years of progressive left-sided sensorineural hearing loss, which has now progressed to constant tinnitus. She endorses mild disequilibrium while walking, but denies true vertigo. Which test is most likely to lead to the correct diagnosis?

A 45-year-old male with a history of alcohol abuse presents to the emergency department with midepigastric abdominal pain radiating straight through to his back and associated with nausea and vomiting. His laboratory values are consistent with the diagnosis of acute pancreatitis. A plain film of the abdomen is obtained (illustrated).

A 79-year-old female was punched n the face during an assault and complains of pain anddecreased vision in her left eye. On physical examina-tion, the affected eye has minimal light perception, and extraocular movements are decreased. Examination of the pupil is limited by blood in the anterior chamber. The injuries are shown in the photographs. Which of the following is the appropriate next step in the management of this patient?:

In which of the following cases is sodium bicarbonate indicated for the treatment of DKA ?

A 57-year-old alcoholic female presented to the emergency department with marked sedation (withdrawal to pain, no eye opening, rare moaning). She had last been seen 18 hours previously, appearing inebriated. Her triage vital signs showed pulse 53 beats per minute, respiration 16 breaths per minute, blood pressure 156/75mmg, and rectal temperature 33.9°C. Her initial arterial blood gas on a nonrebreather showed: pH 6.78; Paco2 12mmHg; Pao334 mmHg; and HCO 1.7 mEq/L. A computed tomography scan of her brain was emergently obtained and is seen here. Which of the following alcohols is most likely responsible?

You are the emergency physician taking care of a patient, who may be presenting with new onset myasthenia gravis. You plan to perform a Tensilon (edrophonium) test to help aid in your diagnosis. What other medication should you have at bedside when giving the edrophonium intravenously?

A 60-year-old male with a history of alcohol abuse presents with mid-epigastric abdominal pain. He is febrile to 39.3 degrees Celsius and has a blood pressure of 95/50. You suspect acute pan-creatitis. Labs show a bedside glucose of 350 mg/dL, WBC 23 x 10°9/L, AST 300 U/L, and ALT 230 U/L. What key initial lab result is missing to calculate Ranson's criteria at admission for pancreatitis-associated mortality?

A 60-year-old woman with acute myeloblastic leukemia currently undergoing chemotherapy presents with chest pain and confusion. She is tachycardic and hypotensive with clear lungs. Her EKG shows a regular, narrow complex tachycardia with low voltage. The patient is on warfarin for a prior deep venous thrombosis and her INR level is therapeutic. A portable chest radiograph is significant for cardiomegaly. Which of the following is the most appropriate next step in management?

which foodborne disease typically causes symptoms within 24 hours ?

A patient presents with possible Middle East Respiratory Syndrome (MERS). Which of the following symptoms would suggest an alternate etiology?

A 38-year-old man presents to the emergency department on a Saturday night with a injury to his right hand. He states that he simply bumped his hand on a bar stool. On examination, there is swelling over the dorsum of the hand and tenderness over his right fifth metacarpal; the motor, sensory, and vascular examinations are normal. An X-ray is obtained (see illustration). What is the next appropriate management strategy at this time?

Paramedics call to inform you they’re bringing a pregnant woman who says she 8 months pregnant and was in a motor vehicle accident. He is hypotensive with a BP of 70/p. They have her immobilized and flat on a spine board. how should you respond?

A patient suffering from psychological trauma is considered to have what type of blast injury ?

48. An 8-year-old girl presents to the pediatric emergency department for increased restlessness, irritability, and clumsiness for the past two days that has resulted in her being asked to leave class. She was previously healthy, except for a sore throat and rash that self-resolved last month. On examination, she appears restless and is having irregular, continuous involuntary movements that worsen with purposeful action. What is the most likely diagnosis?

A 36-year-old male is bitten by the snake shown below. Which of the following symptoms is the patient MOST likely to experience?

A 32-year-old male without a medical history, presented via ambulance to emergency department with chest pain. The pain was left-sided in location and worsened upon both inspiration and reclining. The examination revealed a young patient in moderate distress due to chest pain. A rhythm strip and 12 lead ECG are noted in the figure. Laboratory studies were normal, and the chest radiograph revealed a normal heart size and lung fields. The patient received intravenous, morphine sulfate and ketorolac, which reduced the pain. The ECG in a patient with the disease represented in this case, can show all of the following, except:

A 70 year old male presents with foot pain. on exam his foot is cold and pulseless. what is the Most likely cause?

Which of the following statements is true regarding varicella pneumonia in adults

Of the following, which test is considered the most sensitive and specific for acute cholecystitis?

A 35 year old man fractures his clavicle while wrestling his grandmother. X-ray shows a displaced fracture of the mid shaft of the left clavicle with significant shortening. What is the best treatment?

A 25-year-old, previously healthy female presents with a complaint of eye pain for 3 days. She denies associated fever or chills. She has no change in her vision. She denies nasal discharge or sinus pres-sure. She initially noted redness of her eyelid, which then progressively swelled and became more painful. Her physical examination (noted in the picture) reveals her eye lid and surrounding soft tissue to be warm and swollen. Her extraocular movements are intact, her visual acuity is normal, her pupillary reflex is intact, and her conjunctiva is noninflamed. Her vital signs are normal, and she is afebrile. Which of the following is the next correct step in her management?

A scuba diver, loses consciousness, while ascending, which of the following is the most likely cause?

Which of the following should NOT be performed in a patient in whom premature rupture of membranes is suspected?

Which of the following statements is true regarding treatment of COPD ?

Which of the following is true regarding cardiac arrest in children?

A 32-year-old male with no significant past medical history presents with 10 days of fever and sore throat. His vital signs are significant for a temperature of 100.3° Fahrenheit. His exam is significant for mild erythema to the oropharynx and both anterior cervical and inguinal lymphadenopathy. A point-of-care strep screen and an anti-heterophile antibody test are both negative. Upon further questioning, the patient reveals that he had unprotected receptive anal intercourse with a stranger 6 weeks prior. The patient consents to human immunodeficiency virus (HIV) testing. Which test is recommended to detect the early stage of HIV infection?

A 16 year old girl dislocated her patella while playing volleyball. Which of the following is true?

A 25-year-old male unrestrained driver involved in a head-on collision with another vehicle presents with a complaint of chest and abdominal pain. There was no airbag deployment, and the car was moderately damaged. Vital signs are blood pressure 95/60 mmHg, pulse 120 beats per minute, respiration 20 breaths per minute, and oxygen saturation 100% on room air. The examination is significant for the skin finding noted in the figure, crepitus over the left lateral chest wall, and left upper quadrant abdominal tenderness. Which statement is true regarding this injury?

A 24-year-old female patient with no medical history of significance, transported to the emergency department via paramedics, had been complaining of sudden weakness and palpitations. All her symptoms had resolved prior to the paramedics' arrival at the scene. In the emergency department, the patient noted a recurrence of her symptoms; examination at that time demonstrated an alert patient with minimal distress. The vital signs were: blood pressure 100/70 mmHg, pulse 240 beats/ minute, and respiration 38 per minute. The monitor revealed a rapid, wide complex rhythm. The patient received amiodarone intravenously. During the infusion, she become lethargic with a sudden reduction in blood pressure. Immediate electrical cardioversionv was undertaken with a return of a normal mental status and the second ECG noted here. The remainder of examination normalized as well. Of the initial interventions, the most appropriate initial intervention is:

What is the most common cause of superior vena cava syndrome?

A 25-year-old male spent several days on a climbing trip. The climber experienced significant abrasions to his hands as well as numerous tears of the skin on his fingers. Two days after completing the trip, he noticed increasing pain on his lateral aspect of his right first digit. He soaked this digit in warm saltwater, but over the course of several days the reddening and swelling increased. By the sixth day after returning from the climb, the climber reported that he was able to express pus from the area. Similar areas of redness also developed on the cuticles of his left first digit. The climber presented to emergency department 10 days after the redness first appeared with the skin findings illustrated here. What is the name of this infection?

A 5-year-old girl with a history of congenital hydrocephalus and ventriculoperitoneal (VP) shunt presents with irritability, nausea and severe headache. The shunt was placed 3 years ago and has not been revised since. Her vital signs are unremarkable, and he physical examination is unrevealing. While awaiting neurosurgic consultation, what is the next most appropriate step in the mana ment of this patient?

A 65-year-old male with an unknown medical history is brought in by ambulance with altered mental status after being found unconscious in his parked car on a hot summer day. You note that he appears very dry and his skin is warm to the touch. His initial vital signs include a blood pressure of 105/75, heart rate of 122, respiratory rate of 24, and oxygen saturation of 96%. A rectal temperature is obtained and measures 40.5 degrees Celsius. What is the most rapid method of cooling this patient?

A 55-year-old female with hypertension presents with worsening headaches over the past 4 months. The headache, initially only present in the morning, has gradually increased in duration during the day. Suddenly this morning, she vomited once without prior nausea. On exam her vital signs are T 96.8°F, BP 180/56, HR 62, RR 14, SpO2 100% on room air. She is lethargic on exam without cranial nerve deficits. Her speech is normal, breath sounds are clear, and distal extremities have strong pulses. There is 3/5 right upper extremity strength and 5/5 strength in all other extremities. Her husband reports she was moving all her extremities normally 2 hours prior to arrival. What are the next steps in her management?

A 22-year-old previously healthy female presents with malaise, fe-ver, vomiting, and diffuse abdominal pain for the past week. Today she developed jaundice. She states that six weeks prior, she was studying abroad in India. She took malaria prophylaxis, but refused any vaccinations because she is afraid of needles. In the emergency department, she is febrile but with otherwise normal vital signs. Her exam is significant for scleral icterus, jaundice, mild hepatomegaly, and right upper quadrant tenderness to palpa-tion. Her labs are significant for transaminitis with an elevated bilirubin. What is the best test to confirm the diagnosis?

A 33-year-old postpartum female presents with an acute headache and first time seizure. Her blood pressure is 122/70. Her physical exam is significant for bilateral papilledema. Which of the following diagnostic modalities is MOST likely to provide the definitive diagnosis?

Which of the following foreign bodies should be the most emergently removed?

What is the most likely diagnosis in a father and son, who present together with abdominal pain, flushing, and pruritus after eating at a restaurant?

A 67-year-old male with prostate cancer, undergoing radiation therapy, presents with severe lower back pain that woke him up at night, and is newly incontinent of urine. What is the next management step?

which of the following helps to differentiate a sympathomimetic crisis from an anticholinergic crisis ?

A 45-year-old male immigrant from Morocco presents with neck discomfort and swelling. Three months previously, this area of his neck was initially swollen with only a single mass noted. Over the last month, the area began to drain and he has noted an increase in the number of masses. He also has had an unexpected 30 pound weight loss over the last year, with associated night sweats. He denies any other illnesses. He lives alone and is employed as a taxi driver. His examination is unremarkable except for the neck examination depicted here. There are also multiple 2-6 cm, matted, soft, and in one case fluctuant, mildly tender masses along the posterior cervical chain. Which of the following illnesses would be the most likely cause of this patient’s illness?

A 23-year-old male native of Hong Kong presents with near syncope after a prodrome that has included nausea, vomiting, paresthesias of the extremities, and dyspnea. His initial vital signs are: pulse32 beats per minute, blood pressure 75/32 mmHg, respiration 22 breaths per minute. The remainder of his physical examination is unremarkable. The family brings in an herbal product with a picture of this plant on the label. What would be the next most appropriate step in his management?

Case presentation: A 2-year-old boy with no medical history presents to the emergency department with complaints of a diffuse rash over his bilateral lower extremities for the past 2 days that is now progressing to his trunk and upper extremities. He otherwise appears playful and wellwith no complaint of itching or fever. His parents deny new detergents, creams, or drug exposures. They do, however, report mild upper respiratory symptoms 1 week ago. On physical examination, he has multiple confluent lesions with central clearing diffusely. The lesions are present on his palms and soles but are most prominent on his bilateral lower extremities. There is no conjunctival injection, and there are no sores in or around his mouth or genital area. What is the next most appropriate management strategy at this time?

What is the preferred vasoactive agent to treat cold shock?

A 21-year-old man complains of left wrist pain after falling from a 5-foot ladder onto his left hand. On examination, there is swelling and tenderness over his wrist, and the examination is limited due to pain over the dorsum of his hand. The motor function is strong, and the sensory and vascular examinations are otherwise normal. The wrist radiographs obtained are noted here. What is the most likely injury?

An 8-year-old boy presents to the emergency department with a rash for 2 days and an inability to ambulate due to bilateral ankle pain. The family reports that the rash began on his legs and is now more generalized. It is neither painful nor pruritic. The child appears well, with normal vital signs. The skin lesions (pictured) are palpable and purple in hue and do not blanch with pressure. The ankles are warm to the touch and have minimal periarticular swelling, but no intra-articular fluid. On examination, the right wrist is also painful and warm with periarticular swelling. The rest of the examination is normal. Laboratory tests reveal a normal complete blood count, coagulation studies, elec-trolytes, and urinalysis. A blood culture is pending. What would be your next step in managing this patient? :

Which of the following statements is true regarding airway management of an obese patient?

Which of the following is a known complication of ischemic central retinal vein occlusion?

Which of the following is an indication for dialysis in a case of salicyclate overdose?

A 46-year-old female with a history of Hodgkin's lymphoma, in remission, presents to the emergency department with 2 days of non-bloody diarrhea, rash, nausea, fatigue, fever, and chills. She had been in her usual state of health prior to this acute illness. The only recent medical care she received was 2 weeks prior when she received a blood transfusion for symptomatic anemia related to menorrhagia. Her labs are significant for severe pancytopenia, elevated liver enzymes, and elevated total bilirubin. The hematologist suspects her illness may be related to the blood transfusion she received 2 weeks prior. What is the most likely diagnosis and what step could have been taken to prevent this?

An 8-day-old male infant is brought to the emergency department by his grandparents with cyanosis. His mother has a history of bipolar disorder and did not seek prenatal care. The infant was born at home with the help of a doula. The grandparents came to visit and were alarmed to find a lethargic infant with blue discoloration of the mouth and perioral area. On examination, the infant is afebrile with a heart rate of 140, systolic blood pressure 60 mmHg, and respiratory rate of 42. He is cyanotic and on auscultation you appreciate a holosystolic murmur at the third intercostal space along the left sternal border. Chest x-ray reveals a balloon shaped heart. ECG shows a pre-excitation pattern with left bundle branch block and echocardiogram shows moderate tricuspid regurgitation with inferior displacement of the tricuspid valve, as well as a large right atrium and an atrialized right ventricle. Which of the following do you suspect this infant was exposed to in utero?

A 61-year-old woman with hypertension and tobacco use presents to the emergency department with headache, nausea, and vomit-ing. The headache started suddenly 10 hours ago at work and reached maximal intensity within seconds. On exam, she is hypertensive with a blood pressure of 156/100 mmHg and a left third nerve palsy. A non-contrast head CT scan is normal. What is the next appropriate management step?

A six day old infant presents to the ER with watery eye drainage, which of the following is the best course of action ?

A 42-year-old healthy male prèsents to the emergency department with 6 months of worsening left-sided hearing loss. The patient reports a constant buzzing sound from the left ear over the past month and new onset vertigo today. His vital signs are stable. His exam is unremarkable including otoscopy and neurologic exam. His non-contrast CT head is negative. The patient is given meclizine without improvement in symptoms. What is the next step in management?

A 24-year-old intoxicated male presents to the emergency department after striking a wall with his hand at an oblique angle. He noted significant pain at onset but denies any other complaints. On examination, the hand demonstrates significant tenderness and soft tissue swelling in the medial-dorsal area. Radiographs, an anteroposterior view of the hand/ wrist and lateral view of the hand/wrist, have been obtained and are shown here. The most appropriate diagnosis to describe this injury is:

An 88-year-old man presents with sudden onset of painless vision loss. The patient was reading in bed when he was suddenly unable to see out of his right eye. On physical exam, the patient has a right-sided afferent pupillary defect. Visual acuity is light perception on the right and 20/30 on the left. Your fundoscopic exam demonstrates a cherry red spot on the macula and the bedside ultrasound exam demonstrates no vitreous hemorrhage or retinal detachment. Which of the following is the appropriate treatment for this patient?

Case presentation: A 32-year-old male botanist presents to the emergency department after paramedics received a call from his spouse that he was becoming markedly confused. According to his wife, this occurred after he drank a tea made from one of his plants, with the plant utilized shown here. The patient is notably agitated, following no com-mands, constantly moving in the stretcher, picking relentlessly at the bed sheets, and talking with incomprehensible, mumbling speech. The remainder of his examination is significant for the following: warm and dry to touch; no bowel sounds; pulse 140 beats per minute; blood pressure 160/90mmHg; temperature 38.4°C. An examination of his lips and pupils is shown in the illustrations. A Foley catheter is placed, with a return of 1.5 L of urine. Which of the following could produce the clinical syndrome?:

A 32-year-old intravenous drug user presents with weight loss and fatigue. His vital signs include a temperature of 38.2° Celsius, heart rate of 92, blood pressure of 108/66, respiratory rate of 18, and oxygen saturation of 97%. Which of the following findings is LEAST helpful in supporting a diagnosis of infective endo-carditis?

Case presentation: A 65-year-old man presented to the emergency department with chest pain and syncope. The examination demonstrated an alert man in mild distress with normal vital signs; diaphoresis was present on the examination. The patient suddenly slumped over, unresponsive and without a pulse. The cardiac rhythm strip shown in the figure was obtained. While attempts were made for electrical therapy, the rhythm changed spontaneously to sinus rhythm with a pulse. A 12-lead ECG was obtained and is also shown here. Which of the following would be consistent with the rhythm strip and ECG noted in this case?

A 22-year-old female presents to the emergency department with left foot pain. She was the restrained driver of a car that struck another vehicle head on. She used her left foot to compress the brake pedal just prior to impact. She complains of decreased movement of her toes and says she cannot walk on her left foot. She denies loss of consciousness or any other complaints. Her foot appears mildly swollen, is exquisitely tender along the midfoot, and has normal distal pulses and capillary refill. The following foot radiographs were ordered from triage. What is the most appropriate management strategy at this time?

A 65-year-old male with a history of diabetes mellitus and hyper-lipidemia presents to the emergency department with lethargy and dizziness. Physical examination reveals a decreased level of alertness with a weak palpable pulse. The patient's extremities are cool to touch with a core temperature of 37° Celsius. His ECG demonstrates a complete heart block with a ventricular rate of 36 beats per minute. Which of the following is the appropriate immediate course of action while preparing for transcutaneous pacing?

Case presentation: An 18-year-old South American male was traveling from Miami to New York City by Amtrak train. While at a train station along the way, he was noted by the conductor to be acting oddly and the police were called. On search of his processions, the packets pictured here were discovered. He was subsequently transported by paramedics with police escort to the emergency department. His initial vital signs on presentation are as follows: blood pressure 195/113 mmHg, pulse 143 beats per minute, respiration 36 breaths per minute, and temperature 38.7° C. His examination is significant for confusion, agitation, mydriasis, diaphoresis, and tremor. A radiograph of his abdomen is noted here. Which of the following would be indicated in his management?

What is the recommended management for Alveolar osteitis?

what type of Salter-Harris fracture involves a fracture that extends along the physics to the metaphysis?

A 14-year-old returns from a popular amusement park . In addition to some neat souvenirs, he brings home chickenpox. Which of the following medication’s is contraindicated?

A 24-year-old male presents to the emergency department for a rash and diarrhea. He had a bone marrow transplant pedommed 3 months ago for acute lymphoblastic leukemia. Five days ago, he noticed a rash that began on his hands, which has spread to his arms and chest wall. The rash is pruritic, but not painfal. This was followed by non-bloody diarrhea for the past 4 days. He denies any new medications or changes in his medication regimen He is afebrile with a pulse of 78, blood pressure of 118/78, respiratory rate of 14, and oxygen saturation of 98%. Physical nation reveals a scattered macular and papular rash imoling his palms, arms, and upper chest. The remainder of the examination is unremarkable. Laboratory work is non-contributory What is the next best step in the treatment of this patient?

A patient is cutting wood when he feel something enter his eye. He has immediate pain. CT of the orbit is unremarkable. What is the next best imaging study for evaluation of potential intraocular foreign body?

What is the most common exam finding in patients with aortic dissection?