Reach for it. Push yourself as far as you can. -Christa McAuliffe Welcome back to Roshcast Episode 35! It was great chatting with a bunch of listeners at ACEP last week. We received a lot of excellent feedback. This week, we’ll be doing a couple of diarrhea questions to link up with the last EM Clerkship episode, in addition to a few randomly generated questions. Don’t forget that we are still running a trauma ring tone contest. Listen closely for a ring tone in an upcoming episode and e-mail us at [email protected] or tweet to us at @Roshcast the exact time of the ring tone to win a prize, which will certainly come in handy as we get closer to the in training exam. Let’s get started with a review from recent posts on the Rosh Review Blog. * Pterygium is a fleshy triangular growth from the medial canthus towards the cornea. They are usually slow growing and seen in those with excessive sunlight exposure. They are managed with artificial tears. * Pterygium typically doesn’t require surgery, but may need excision if it is causing a visual disturbance. Make sure the patient is already following with an ophthalmologist or give them a referral if needed. * Retinal detachments present with painless loss of vision, floaters, flashing lights, or as a curtain lowering sensation. On physical, you may see a hazy gray retina with whitish folds. * The most common location for an ectopic pregnancy is the fallopian tube. Now onto this week’s podcast Question 1 A 2-year-old female presents after a witnessed seizure. The parents state that she has not been to day care in 2 days as she has bloody diarrhea and a fever. Her vitals on presentation are T 103.1°F, HR 167, BP 73/43, RR 48, and oxygen saturation 96%. Currently, the patient has a normal neurologic exam and minimal abdominal tenderness. There are no rashes. Labs show a WBC of 19,000 and urinalysis reveals an elevated specific gravity. Which of the following is the most appropriate next step in management? A. Acetaminophen for fever and follow-up with primary care provider B. Blood and stool cultures, IV antibiotics, and admission C. Neurology consultation and admission D. Oral antibiotics and follow-up with primary care provider Teaching Image Question 2 An 82-year-old nursing-home resident is sent to the emergency department with lower abdominal pain and bloody diarrhea. He has a history of vascular dementia, hypertension, and hyperlipidemia. On examination he is afebrile, and a nasogastric aspirate is negative for evidence of bleeding. Which of the following is the most likely cause of this patient’s bleeding? A. Angiodysplasia B. Diverticular bleeding C. Ischemic colitis D. Peptic ulcer disease Teaching Image Question 3 Which of the following is considered a risk factor for suicide? A. Females B. First trimester pregnancy C. First year of marriage D. Recent incarceration Question 4 Which of the following scenarios is most appropriate to safely discharge home a two-year-old who has swallowed a coin? A. The child is not drooling B. The child is tolerating oral sips and the parents are reliable C. The coin is in the stomach D. The coin is oriented in the sagittal plane at the level of the clavicular heads a href="https://www.roshreview.