We aim above the mark to hit the mark. -Ralph Waldo Emerson Welcome back to Episode 23! It was great running into a few listeners at CORD last week and hearing your feedback. This week, we start off with an OB/GYN related pharmacology review before jumping into the new material. Hope you enjoy! * Cervicitis is treated with ceftriaxone 250 mg IM and azithromycin 1 g PO. * Bacterial vaginosis is treated with metronidazole twice daily for 7 days. * Oxytocin or the prostaglandins can both be used in cases of maternal hemorrhage after delivery. Now onto this week’s podcast Question 1 A 16-year-old man presents to the ED complaining of 3 days of nasal rhinorrhea, cough, myalgias, and generalized malaise. After a coughing episode yesterday, he developed pleuritic chest pain radiating to the left neck. His vital signs are BP 130/70 mm Hg, HR 76, RR 16, T 36.6°C, and pulse oximetry 98% on room air. You obtain the chest radiograph seen above. Which of the following is the most appropriate next step in management? A. Discharge home with close follow–up B. Endoscopy C. Needle decompression D. Tube thoracostomy Question 2 A 17-year-old man with no past medical history presents complaining of constant chest pain for 5 days. He states that he had a cold 2 weeks ago and feels like he never got better. His vitals are T 36.8°C, HR 91, BP 122/75, RR 18, and oxygen saturation 99%. A 12-lead ECG is performed as seen above. What is the appropriate immediate management for this patient? A. Aspirin 325 mg and activation of the cardiac catheterization lab B. Azithromycin 500 mg by mouth, followed by 250 mg once a day for 4 days  C. Ibuprofen and prompt follow–up with his primary care doctor  D. Serum d–Dimer test Teaching Image Question 3 An 84-year-old woman with new onset altered mental status is sent to the ED from her assisted living facility. According to the facility staff, she has had a productive cough for two days. Her vital signs are blood pressure 90/60 mm Hg, heart rate 92 beats per minute, respiratory rate 25 breaths per minute, temperature 38.3°C, and oxygen saturation 95% on room air. Laboratory results reveal a WBC of 11,000. A chest radiograph shows a right lower lobe infiltrate. Which aspect of this patient’s presentation is consistent with systemic inflammatory response syndrome? A. Blood pressure B. Heart rate C. Infiltrate on chest radiograph D. White blood cell count Teaching Image Question 4 A 27-year-old woman presents with a complaint of transient vision loss in her right eye. She states that she has had multiple similar episodes in the past 6 months. She also complains of incomplete bladder emptying, intermittent tremors and intermittent weakness in her left arm. The patient has a family history of multiple sclerosis. Which of the following is the best diagnostic test for the suspected diagnosis? A. CSF testing for myelin basic protein B. CT scan of the spine C. MRI D. Serum oligoclonal bands Teaching Image Question 5 Which of the symptoms are most suggestive of Ramsay Hunt syndrome? A. Bilateral petechiae of the palate B. Ear pain, facial paralysis, hearing loss C. Lymphangitis with thrombus formation in the internal jugular vein D. Photophobia and unilateral thoracic vesicular rash