There is only one corner of the universe you can be certain of improving, and that’s your own self. – Aldous Huxley Welcome back to RoshCast for Episode 45! Let’s start out with a review of rabies before getting to core content Q&A. * The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes. Domestic animals like cats, dogs, and cattle can also get rabies. Rodents, reptiles, and birds on the other hand are not carriers and cannot transmit rabies. * One important factor in deciding if you get rabies postexposure prophylaxis is whether the animal can be found and held for observation. * The rabies post-exposure prophylaxis has two parts: the immunoglobulin and the vaccine. * When giving rabies post-exposure prophylaxis, inject the immunoglobulin into the wound and start the rabies vaccine series which the patient will receive on days 1, 3, 7, 14, and 28. Now onto this week’s podcast Question 1 Which of the following is true regarding acute respiratory distress syndrome? A. Define as PaO2:FiO2 > 300 B. Empiric corticosteroids should be given C. Positive end expiratory pressure should be increased with increases in FiO2 D. Tidal volume should be started at 10 mL/kg in intubated patients Teaching Image Question 2 A 35-year-old man presents to the ED after being assaulted in a bar fight. He has signs of significant facial trauma. On physical exam, you note a tooth fracture through the enamel and dentin but does not involve the pulp. Which of the following is the most appropriate next step in management of his dental injury?   A. Calcium hydroxide paste B. Extract the tooth C. Immediate dental consult D. Pencillin VK Teaching Image Question 3 A 62-year-old man presents with acute onset of chest pain with radiation to the shoulders and nausea while walking his dog. On examination, he is diaphoretic with heart rate 94 bpm, respiratory rate 20 bpm, blood pressure 92/59 mm Hg, and oxygen saturation 96% on room air. His ECG reveals 2 mm elevation in aVR. Occlusion of which coronary artery is most likely responsible for this patient’s presentation? A. Left anterior descending artery B. Left circumflex artery C. Left main coronary artery D. Right coronary artery Teaching Image Question 4 A 62-year-old man presents for evaluation of chest pain. Approximately three weeks ago the patient had a myocardial infarction with stent placement. Last evening he developed pleuritic chest pain and fever. He has no cough and does not feel short of breath. His ECG is shown above. Which of the following is the most likely diagnosis? A. Dressler syndrome B. Infarct pericarditis C. Left ventricular aneurysm D. ST segment elevation myocardial infarction Teaching Image Question 5 A 45-year-old man with a history of hypercholesterolemia presents with acute onset of anterior chest pain, nausea, and diaphoresis. His ECG is distinct for upsloping ST elevation in AVR (≥ 1 mm) with ST depressions and tall T waves in the precordial leads. What is the most likely diagnosis? A. Occlusion of the left circumflex artery B. Occlusion of the left main coronary artery C.