EM@3AM

A 23-year-old female presents with acute onset lower abdominal pain with abnormal vaginal discharge. She denies fevers, chills, nausea, vomiting, dysuria, hematuria, diarrhea, and constipation. She is sexually active with one partner of 3 months and inconsistently uses condoms. Speculum exam shows small amount of blood and cervical discharge. What is the likely diagnosis?

A 36-year-old male with a history of HIV presents to the ED complaining of dyspnea on exertion and fatigue. He is not compliant with his anti-retroviral medications. His conjunctivae are pale. There is a painful ulcer to the distal aspect of the tongue and scattered petechiae on his legs. Laboratory evaluation reveals WBC 2,000/microL, Hgb 8.5 g/dL, and platelets 90,000/microL. What do the exam and lab findings suggest?

A 21-year-old male is brought to the ED by EMS after an MVC at 60 mph. He is complaining of severe right lower extremity pain, which EMS splinted. You find no other injuries on your exam, but upon removal of the splint, the patient has a clear deformity. You cannot detect a dorsalis pedis or posterior tibialis pulse on the right. What’s the next step in your evaluation and treatment?

A 33-year-old female presents with blurry vision. She has also experienced intermittent paresthesias in her extremities and weakness. Your motor and sensory exam is normal, but you find internuclear ophthalmoplegia and an afferent pupillary defect. With these intermittent neurologic symptoms and ocular findings, what is the likely diagnosis, and what is your next step in evaluation?

A 37-year-old G4P3003 female at 27 weeks GA presents via EMS for vaginal bleeding. She began having brisk vaginal bleeding after coitus about 30 minutes ago and has saturated 1 pad since onset. She denies associated abdominal pain, cramping, or prior episodes of vaginal bleeding during this pregnancy. On exam, her abdomen is gravid, soft, and non-tender. On external pelvic exam, she has no visible lesions, and the maternal pad she is sitting on is about 50% saturated with blood. What’s the diagnosis? What’s the next step in your evaluation and treatment?

An 8-year-old male was brought in by his parents for continuous screaming for 12 hours. He is grabbing his groin area. He is in distress, and exam demonstrates incarceration of the glans by the foreskin with pronounced glans edema. His testicles appear normal. What’s the diagnosis, and what’s your next step in evaluation and treatment?

An 28-year-old male presents after high-speed MVC with facial pain and loss of consciousness. He has severe facial pain and bruising, conjunctival hemorrhage bilaterally, and facial paresthesias. What is the patient’s diagnosis? What’s the next step in your evaluation?

32-year-old male presents to the ED with vomiting and abdominal cramping. He has Crohn’s disease and has been poorly compliant with his medications. His current episode began as right lower abdominal pain 1 week ago with several episodes of watery diarrhea daily. He developed diffuse cramping, nausea and vomiting 2 days ago and has been unable to tolerate oral intake. He has not passed stool or flatus in 2 days. His abdomen is distended with hyperactive, high-pitched bowel sounds, increased tympany to percussion, and diffuse mild tenderness to palpation without rebound or guarding. What is the most likely diagnosis?

A 43-year-old female presents with altered mental status.  Her husband states she has had weight gain, constipation, fatigue, and skin changes. Vital signs include BP 92/60, HR 48, T 93.2 rectal, RR 13, SpO2 96% on room air. She is alert and oriented x 1, and her neck reveals a well-healed midline anterior neck scar. Her abdomen is soft but distended, and her extremities are cool. What’s the likely diagnosis?

A 53-year-old male presents with nausea/vomiting and complains of turning “yellow”. He denies abdominal pain, fever, alcohol use, or acetaminophen intake. His vital signs are normal, and exam reveals icteric sclerae, jaundice of his face and chest, and hepatomegaly. He has no tenderness to abdominal palpation. What’s going on, and what’s your next step in evaluation and treatment?