Success is not final, failure is not fatal: it is the courage to continue that counts.–Winston Churchill

Welcome back to RoshCast for Episode 48! We’re going to jump right into questions this week. Remember to send us feedback for any changes you would like to see at roshcast@roshreview.com.

Question 1

An 8-year-old previously healthy boy presents with back pain and fever for 4 days. He complains of pain in the low back, which is increased with bending or twisting. The pain radiates down into his left leg. He denies trauma. Physical exam is remarkable only for tenderness to palpation over the lumbar spine. What management is indicated

A. Ibuprofen and follow up with his pediatrician

B. MRI of the lumbar spine

C. Plain radiographs of the lumbar spine

D. Urinalysis

Teaching Image

Question 2

A 40-year-old man is brought to the emergency department after being assaulted during a bar fight. He has proptosis of the right eye with a measured intraocular pressure of 50 mm Hg. A lateral canthotomy is started. Once the Kelly clamp is released from the lateral canthus, what is the appropriate next step?

A. Clamp the medial canthus

B. Cut the inferior crus of the lateral canthal tendon

C. Cut the superior crus of the lateral canthal tendon

D. Recheck intraocular pressure

Teaching Image

Question 3

A 25-year-old man presents to the emergency department after sustaining burns to the hands, legs, and chest after falling into a bonfire. On physical examination, there are partial-thickness burns on the upper half of the anterior torso along with the bilateral palms of the hands and bilateral anterior legs. He weighs 70 kg. You begin to initiate fluid resuscitation using the Parkland formula. How much fluid should this patient receive in the first eight hours?

A. 10,640 mL

B. 4,060 mL

C. 5,320 mL

D. 8,120 mL

Teaching Image

Question 4

A 64-year-old man presents to the emergency department with cough and shortness of breath that has progressively been worsening over the last several weeks. He has also been more fatigued and is unable to get around the house anymore. He denies fever and night sweats. He has a past medical history of hypertension and takes lisinopril daily. He is an immigrant from Argentina where he used to work as a miner. He denies tobacco use. What is the most likely diagnosis based on this chest radiograph?

A. Histoplasmosis

B. Miliary tuberculosis

C. Pneumoconiosis

D. Sarcoidosis

Teaching Image

Teaching Image