It is during our darkest moments that we must focus to see the light. -Aristotle Welcome back to Episode 27 and a big welcome to all the new interns who are only about 1 week into residency! We hope you find Roshcast to be easy to listen to and helpful in your education. As we have said from the outset, we want this to be as high-yield as possible to not only improve your in-training scores but also improve your care at the bedside. We are open to any suggestions, so please reach out. Let’s get warmed up with a rapid review – this week, we are going over some HIV related illnesses. * Toxoplasmosis is rarely seen with CD4 > 200. Be concerned in those with CD4 100. * Toxoplasmosis is transmitted through cat feces. Its treated with pyrimethamine, sulfadiazine, and folinic acid. * The classic X-ray finding for PJP pneumonia is diffuse interstitial infiltrates in a “bat wing” appearance. * In PJP pneumonia, if the PaO2 is less than 70 or the A-a gradient is greater than 36, treat with steroids in addition to trimethoprim-sulfamethoxazole. Now onto this week’s podcast Question 1      A 67-year-old man with hypertension and end-stage renal disease presents after an incomplete dialysis session secondary to shortness of breath. His vital signs are BP 110/95, HR 65, RR 22, T 37.3°C, and oxygen saturation 99% on 2L NC. You obtain the ECG shown above, which shows a widened QRS, almost resembling a sine wave. Which of the following is the most appropriate next step in this patient’s management? A. Calcium gluconate B. Cardiology consultation C. Defibrillation D. Transcutaneous pacing Teaching Image Question 2 EMS calls notifying you that there is a mass casualty situation. There was an explosion at a construction site and they will be bringing 20 ambulatory, asymptomatic patients to your emergency department. After checking airway, breathing and circulation, what test, if normal, would allow you to rapidly discharge patients? A. Abdominal ultrasound B. Ophthalmoscope evaluation of the eye C. Otoscope evaluation of tympanic membranes D. Oxygen saturation Question 3 A 42-year-old woman with sickle cell anemia presents to the ED complaining of unilateral knee pain. You are worried she might have septic arthritis. Which of the following organisms is most likely to be responsible? A. Pasturella multocida B. Pseudomonas aeruginosa C. Salmonella spp. D. Staphylococcus aureus Teaching Image Question 4 In which of the following spondyloarthropathies is uveitis the most common extra-articular manifestation? A. Ankylosing spondylitis B. Fibromyalgia C. Psoriatic arthritis D. Reactive arthritis Question 5 At which location is the pediatric airway the narrowest? A. Cricoid B. Epiglottis C. Pharynx D. Vocal cords Teaching Image Question 6 A 29-year-old man presents to the ED with partial thickness burns to his entire back and right arm. The patient weights 70 kg. Based on the Parkland formula, how much crystalloid solution is required in the first 24 hours? A. 1,260 mL B. 10,080 mL C. 5,040 mL D. 7,560 mL Teaching Image * EKG changes seen in patients with hyperkalemia include p...