Shoot for the moon and if you miss you will be among the stars. – Les Brown Welcome back to Episode 24! We are coming to you live from Orlando at SAEM this week. Ok, it is not exactly live, but we are launching this episode from Orlando. Although the venue has changed, we have the same high quality review for you this week. This week we begin with a renal rapid review and then get into the new material, starting with some OB and virology, and ending with the more obscure, but still important, altitude related emergencies. Hope you Enjoy! * When considering children with glomerulonephritis, in a child with mild to moderate edema, a normal blood pressure, and no respiratory symptoms, discharge home with corticosteroids may be appropriate. * Winter’s formula, pCO2 = 1.5HCO3– + 8 ± 2, is used to determine if there is appropriate respiratory compensation in a metabolic acidosis.   * The causes of a non-anion gap metabolic acidosis can be remembered with the mnemonic HARDASS: Hyperalimentation, Addison’s disease, RTA, Diarrhea, Acetazolamide, Spironolactone, and Saline infusion. Now onto this week’s podcast Question 1 A 17-year-old G1P0 woman at 25-weeks gestation presents with intermittent blurred vision. On presentation, she is asymptomatic. Vital signs are HR 84, BP 175/113, and oxygen saturation 97%. Physical examination reveals 2+ pitting edema on both lower extremities and urinalysis has 3+ protein on dip. Which of the following is most likely indicated? A. Admit for further obstetrics evaluation B. Antiepileptic medications C. Arrange follow up with the patient’s obstetrician D. Emergency cesarean section Teaching Image Question 2 Which of the following fish poisonings is associated with a peppery taste? A. Aeromonas B. Ciguatera C. Scombroid D. Vibrio Teaching Image Question 3 What is the most common cause of viral pneumonia in adults? A. Influenza virus B. Metapneumovirus C. Parainfluenza virus D. Respiratory syncytial virus Teaching Image Question 4 Which of the following is the most common visceral artery aneurysm? A. Hepatic artery aneurysm B. Inferior mesenteric artery aneurysm C. Splenic artery aneurysm D. Superior mesenteric artery aneurysm Teaching Image Question 5 A 14-year-old woman is brought to your mountaineering base camp at 11,000 feet for evaluation of strange behavior while attempting to summit a nearby peak with her school group. What is the most sensitive clinical sign in diagnosing high-altitude cerebral edema? A. Cerebellar ataxia B. Cranial nerve VI palsy C. Ptosis D. Seizure Teaching Image Question 6 A 33-year-old man presents to the ED with right eye pain, tearing, and “difficulty seeing” out of the right eye. His visual acuity is 20/30 on the left and 20/200 on the right. On physical exam, you notice a subconjunctival hemorrhage and teardrop-shaped pupil. Which of the following physical exam findings is consistent with the suspected diagnosis? A. Cells and flare in the anterior chamber on slit lamp exam B.