Always do your best. What you plant now, you will harvest later.–Og Mandino

Welcome back to RoshCast for Episode 43! After a long pause, we are back with new episodes and a lot of announcements. A lot has happened in the past few months. Jeff had a baby and moved to Pittsburg to start his EMS fellowship. In doing so, he is taking a break from Roshcast to focus on fellowship and his new baby. Megha Rajpal, a fourth-year resident at Mount Sinai, will be taking over as co-host.

• For epiglottitis, the patient will usually have a rapid-onset fever and dysphagia. On exam, they could be leaning forward, drooling, and even have inspiratory stridor. The typical radiographic finding for epiglottitis is thumbprint sign, which is seen on a lateral neck film. The most common bacteria associated with epiglottitis are H. influenzae and Streptococcus.* For management in epiglottitis, airway is the crucial piece. Patients may need to be intubated immediately. Don’t forget to start the patient on antibiotics to treat for the common pathogens.

Now onto this week’s podcast

Question 1

Which of the following is the most common presenting vital sign abnormality seen in patients presenting with a pulmonary embolism?

A. Fever

B. Hypoxia

C. Tachycardia

D. Tachypnea

Teaching Image

Question 2

A 72-year-old man presents with pain in the right knee. It has increased over the last 24 hours with redness and swelling. Joint aspiration reveals negative birefringent crystals. He reports an allergy to NSAIDs and is a brittle diabetic. Colchicine is prescribed. Which side effect limits its usefulness due to a narrow therapeutic window?

A. Headache

B. Nausea and vomiting

C. Rash

D. Sore throat

Teaching Image

Question 3

A patient presents to the ED after waking up and finding that he was drooling while drinking his coffee. When he looked in the mirror he noticed that the left side of his face was drooping. Which of the following findings is suggestive of a central process?

A. Hyperacusis of the left ear

B. Inability to close the left eye completely

C. Loss of taste sensation

D. Preserved ability to raise the eyebrows

Teaching Image

Question 4

Which of the following is considered a stable cervical spine injury?

A. Bilateral facet dislocation

B. Clay-shoveler’s fracture

C. Hangman fracture

D. Teardrop fracture

Teaching Image

Question 5

A 28-year-old man presents to the emergency department via ambulance after a terrorist set off a large bomb in an airport. On physical exam,