Success is the sum of small efforts, repeated day in and day out. -Robert J. Collier Welcome back to Episode 29! This week we are starting out with a bit of psychiatry before swinging over to the Pediatric ER for a quick neonatal resuscitation. We may even stop by the trauma bay to see what is happening there and give you a chance to win a prize. We’ve said enough already. Let’s get warmed up with a rapid review. This week, we are trying something new – we will be reviewing some of the recent Rapid Reviews that Yehuda has been uploading to the blog. Make sure to check them out going forward too! * With primary hypothyroidism, you would expect a high TSH and a low T4. On physical, you may see periorbital edema, dry skin, and coarse brittle hair.  Patients often complain of weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain. * With acanthosis nigricans you would expect thickened, velvety, darkly pigmented plaques on the neck or axillae.   * Cushing’s syndrome most commonly caused by hypercortisolism from an ACTH-secreting pituitary tumor. Cushing’s syndrome is diagnosed by a 24h urine cortisol and serum ACTH levels. Now onto this week’s podcast Question 1 You are working in the ED when the police bring in a 26-year old man who was involved in a bar fight. The patient is well known to staff as he frequently seeks treatment in the ED for injuries related to fights and alcohol abuse. He has been caught smoking cigarettes in the ED bathroom, has urinated on the floor, and been known to steal food trays and other patients’ belongings. As you enter his examination room, you overhear him giving the registration clerk a false identity. Which of the following personality disorders best fits with this patient’s behavior? A. Antisocial B. Borderline C. Paranoid D. Schizoid Teaching Image Question 2 A term pregnant patient presents to the ED in active labor and delivers. There is no meconium seen, but the baby has a weak cry and poor tone initially. After clearing the airway, drying the baby vigorously, and providing warmth, the poor tone persists. On exam, the heart rate is 85 and the newborn appears apneic. Which of the following is the most appropriate next step? A. Administer atropine B. Administer epinephrine C. Begin chest compressions D. Provide positive-pressure ventilations Teaching Image Question 3 A 13-year-old boy with no past medical history presents with a headache 3 days after a closed head injury. The patient states that he stood up from kneeling and hit the top of his head on a wood cabinet. There was no loss of consciousness or seizure activity. In addition to the headache, he complains of difficulty concentrating at school and dizziness. His physical examination is unremarkable. What management is indicated? A. CT scan of the head with contrast B. CT scan of the head without contrast C. MRI of the brain D. Neurology referral Teaching Image Question 4 Which of the following organs is the most commonly injured in adult blunt abdominal trauma? A. Bladder B. Intestine C. Liver D. Spleen Teaching Image Question 5 An 18-year-old man presents with red eyes.