EM@3AM

A 72-year-old male presents with fatigue for months. He sometimes has prolonged bleeding when he brushes his teeth. He denies weight loss, night sweats, or any other symptoms apart from his fatigue. He has no significant past medical or surgical history, and his VS are normal. Exam is unremarkable except for one hemorrhagic bullae on his oral mucosa. He has no lymphadenopathy or hepatosplenomegaly. What are the next steps in management?

A 61-year-old male presents in middle of July with altered mental status. The patient’s son states the patient has been increasingly weak for the past three days. The patient has been having multiple episodes of non-bloody diarrhea with associated decreased appetite. Initial triage vital signs include BP 104/66, HR 111, RR 18, SpO2 99%, Temp 36.9 C.
He appears clinically dehydrated with dry mucous membranes and poor skin turgor with tenting. An initial rapid VBG reveals a sodium of 161 mEq/L.

A 23-year-old female presents with left foot pain after rolling her ankle in volleyball. She has some minor ankle pain, but her lateral foot is painful to touch or with weightbearing. On exam, the base of her 5th metatarsal is tender to palpation, with swelling and ecchymosis. What are your next steps, and what is the likely diagnosis?

A 61-year-old male presents with lower abdominal pain on the right side. He says “I’ve had this bulge in my groin on the right for two days”. You find a small bulge in the right groin, but with no redness or discoloration of the skin. Palpation reveals mild tenderness over the site. What’s the next step in your evaluation and treatment?

A 57-year-old male presents with hematemesis. He has a history of cirrhosis from alcohol abuse. He appears toxic and is rushed to the resuscitation bay.  Initial VS include T 37.2C, HR 122, BP 88/41, RR 24, SpO2 90% RA. What are your next steps, and what is the likely diagnosis?

A 33-year-old male comes in to the emergency department after a soccer game with right foot pain and swelling.  He has been unable to bear weight on his right foot since the injury and has noticed increased pain and swelling to the area. Physical exam reveals a patient in mild discomfort with right foot swelling and pain. He is unable to bear weight, and right foot exam is notable for midfoot edema with plantar ecchymosis. What is the diagnosis, and what are your next steps?

A 77-year-old female presents with left proximal femur and hip pain after falling from a standing position. She tripped over a rug and landed on her left side. She denies LOC or other symptoms. Her left leg is shortened and externally rotated. Her pulses in the leg are normal, and she is able to move her foot and toes. What are your next steps, and what is the likely diagnosis?

A 37-year-old male presents with altered mental status. He has a history of recurrent alcohol intoxication, and his wife found him on the couch after he was working in the garage. She is concerned because he seems to be much more intoxicated than is usual. She also found spilled containers of antifreeze in the garage. What could be going on with this patient? Is he just intoxicated?

A 37-year-old female presents with dysuria, polyuria, polydipsia, and lightheadedness. She has a history of insulin-dependent diabetes but ran out of her glucose strips at home. She has had significant nausea and suprapubic pain. She is tachycardic and tachypneic. Exam reveals dry oral mucosa and suprapubic tenderness. POC glucose is 422 mg/dL. What is the diagnosis, and what are your next steps?

A 28-year-old female presents with right lower leg swelling and redness. She just returned from an overseas flight. She denies chest pain or shortness of breath. VS are normal, and her right lower leg is swollen, with diameter > 3 cm compared to her left. What’s the next step in your evaluation and treatment?