A 2 year old boy presents with his mom for recurrent bouts of abdominal pain and vomiting. Mom denies fevers but noticed decreased appetite. Mom states there has been a "stomach bug" going around the daycare. Vitals reveal a blood pressure of 90/50, heart rate of 120, rectal temperature of 99.0, respiratory rate of 36, SpO2 of 100% on room air. Exam is unremarkable, revealing a playful child with a normal abdominal and GU exam. The nurse asks you to reassess the patient and you see a very uncomfortable child, crying and holding his abdomen, his legs drawn toward his abdomen.
A 32 year old male history of IV drug use presents for redness to his right arm extending the antecubital fossa. He has pain out of proportion to the area and pain outside of the erythematous margins. He is febrile to 103.2 F, heart rate is 125, blood pressure is 80/40. Patient is given normal saline. Vancomycin and Cefepime are started. What is the next step in management?
A. Immediate Surgical Consult and Clindamycin.
B. Draw labs to risk stratify via the LRINEC score and a CT scan
C. Immediate Surgical Consult and a CT scan.
A 30 year old male with no past medical history presents to the ED for epistaxis. You notice actice bleeding from right nare but cannot determine the exact source. Direct pressure was attempted for 20 minutes followed by application of a topical vasoconstrictor bleeding persists. What is the next best step in management of this patient's epistaxis?
B. Posterior Packing
C. Anterior Packing
D. Cautery with silver nitrate
Answer: C - Anterior Packing
A 35 year old female presents to the Emergency Department with sudden onset of right lower dental pain. Patient had a dental extraction for a dental carie 5 days ago. What is the most likely diagnosis?
A. Acute Necrotizing Ulcerative Gingivitis
C. Dental Abscess
D. Alveolar Osteitis
E. Post-Extraction Pain
Answer is D - Alveolar Osteitis (Dry Socket)
Loss of healing clot leads to pain and inflammation 3-5 days post extraction.
A 50 year old male with history of atrial fibrillation and a seafood allergy presents after eating seafood. He is on a beta-blocker for rate control. He has facial swelling, hives, trouble breathing and nausea. You give epinephrine x 2 intramuscularly but the patient is not improving. What is your next step in management.
A. Epinephrine IM
B. Epinephrine IV
Answer: C - Glucagon
A 25 year old female presents with plaquenil overdose. She is hypotensive with a systolic blood pressure of 70. She complains of dizziness. EKG shows QRS widening. You initiate 2L of normal saline but her systolic blood pressure persists in the 70s. What is your vasopressor of choice?
Answer: B - Epinephrine
A 12 year old female is tackled in a soccer game. She arrives with her knee in flexion and her patella laterally displaced. She is neurovascularly intact. Skin is intact. She cannot extend the knee. What is the diagnosis?
A. Patella Dislocation
B. Knee Dislocation
C. Quad Tendon Rupture
D. Patella Tendon Rupture
Answer is A - Patella Dislocation
A 2 year old boy is brought to the Emergency Department after a drowning event. Bystanders noted the child was underwater for 1 minute but was quickly pulled from the bottom of the pool, he coughed and vomited. On arrival, he is aware and alert and behaving appropriately per parents. His GCS is 15. On examination, he has a heart rate of 110, respiratory rate of 30 breaths/minute SaO2 of 98% on room air. His lungs are clear. What is the next step in management?