Always do your best. What you plant now, you will harvest later. -Og Mandino Welcome back to RoshCast for Episode 43! After a long pause, we are back with new episodes and a lot of announcements. A lot has happened in the past few months. Jeff had a baby and moved to Pittsburg to start his EMS fellowship. In doing so, he is taking a break from Roshcast to focus on fellowship and his new baby. Megha Rajpal, a fourth year resident at Mount Sinai, will be taking over as co-host. * For epiglottitis, the patient will usually have a rapid onset fever and dysphagia. On exam, they could be leaning forward, drooling, and even have inspiratory stridor. * The typical radiographic finding for epiglottitis is thumbprint sign, which is seen on a lateral neck film. * The most common bacteria associated with epiglottitis are H. influenzae and Streptococcus. * For management in epiglottitis, airway is the crucial piece. Patients may need to be intubated immediately. Don’t forget to start the patient on antibiotics to treat for the common pathogens. Now onto this week’s podcast Question 1 Which of the following is the most common presenting vital sign abnormality seen in patients presenting with a pulmonary embolism? A. Fever B. Hypoxia C. Tachycardia D. Tachypnea Teaching Image Question 2 A 72-year-old man presents with pain in the right knee. It has increased over the last 24 hours with redness and swelling. Joint aspiration reveals negative birefringent crystals. He reports an allergy to NSAIDs and is a brittle diabetic. Colchicine is prescribed. Which side effect limits its usefulness due to a narrow therapeutic window? A. Headache B. Nausea and vomiting C. Rash D. Sore throat Teaching Image Question 3 A patient presents to the ED after waking up and finding that he was drooling while drinking his coffee. When he looked in the mirror he noticed that the left side of his face was drooping. Which of the following findings is suggestive of a central process? A. Hyperacusis of the left ear B. Inability to close the left eye completely C. Loss of taste sensation D. Preserved ability to raise the eyebrows Teaching Image Question 4 Which of the following is considered a stable cervical spine injury? A. Bilateral facet dislocation B. Clay-shoveler’s fracture C. Hangman fracture D. Teardrop fracture Teaching Image Question 5 A 28-year-old male presents to the Emergency Department via ambulance after a terrorist set off a large bomb in an airport. On physical exam, he has bilateral tympanic membrane ruptures. Chest X-ray shows bilateral pulmonary contusion. These injuries are most consistent with which category of blast injury? A. Primary B. Quaternary C. Secondary D. Tertiary Teaching Image Question 6 A 19-year-old man presents with eye pain and photophobia in his left eye after being punched there two days ago. He describes blurry vision. On exam, you note consensual photophobia. Which of the following is the most appropriate treatment? A. Homatropine drops B. Timolol C. Topical ketorolac drops D.