A hero is someone who has given his or her life to something bigger than oneself. -Joseph Campbell Welcome back to RoshCast for Episode 50! Wow!! We can’t believe we’re already at Episode 50. It’s been a real journey building this podcast from the original concept two years ago. And in the last year, we have seen some pretty big changes, including Megha joining the team. We are excited to see how RoshCast continues to evolve over the next fifty episodes and two years. None of this would be possible without you, our listeners. Your listenership and feedback is what drives us to keep delivering high quality content! We value every moment you give your attention to us, and we try our best to design the episode to maximize your learning. We have a pretty involved process for choosing questions to present to you and for how we manipulate and deliver the content before we get it to your ears. With that, let’s kick off to a great episode! Question 1 A 70-year-old woman with history of coronary artery disease, hypertension, and diabetes presents to the emergency department with chest pressure and shortness of breath. Her exam is notable for a new holosystolic murmur best heard over the midaxillary line as well as diffuse bilateral rales. Which of the following is most likely to be seen on this patient’s ECG? A. Biventricular tachycardia B. S1Q3T3 pattern C. ST-depressions in I, V6, and aVL without ST-elevations D. ST elevations in II, III, aVF Teaching Image Question 2 A 26-year-old woman with no medical history presents with bleeding gums after brushing her teeth for the last 3 days. Her complaint was preceded 2 weeks ago by a URI. Her examination is unremarkable except for oozing from the gums. Labs show a platelet count of 23,000. Which of the following is the most appropriate next step in management? A. IV immunoglobulin B. Platelet transfusion C. Steroids, IV immunoglobulin D. Steroids, IV immunoglobulin and platelet transfusion Teaching Image Question 3 Which of the following is most suggestive of measles infection? A. A prodrome of fever, lymphadenopathy, and conjunctivitis followed by a maculopapular rash that starts on the face and spreads to the trunk and limbs B. Diffuse maculopapular rash with white spots on the buccal mucosa C. High fever for 3 days followed by the appearance of a pink maculopapular rash after defervescence D. Presence of shallow ulcers on oral mucosa and vesicular lesions on the palms and soles Teaching Image Question 4 A 23-year-old man who has unprotected, receptive anal intercourse presents to the ED with two weeks of worsening rectal pain and dyschezia. On exam, he has numerous ulcers in the anorectal area and a crop of grouped vesicles containing clear fluid on an erythematous base. The surrounding skin shows no sign of cellulitis or abscess. Which of the following is the most appropriate next step? A. Refer the patient to a surgeon for operative intervention B. Send a serology test C. Send a Tzanck smear D. Treat with acyclovir Question 5 A 5-year-old boy with von Willebrand’s disease presents with persistent bleeding after he lost a tooth 4 hours ago. Vital signs are unremarkable. Physical exam reveals oozing at the site of the tooth which persists despite pressure. Which of the following is the most appropriate treatment? A. Desmopressin B. Factor VIII concentrate C. Fresh Frozen Plasma D. Vitamin K