A 95-year-old man presents to the emergency department with…

A 95-year-old man presents to the emergency department with sudden onset inability to speak or use the right side of his body. His family noticed these changes roughly 5.5 hours prior to presentation. The patient has an extensive past medical history including hypertension, multiple prior strokes, coronary artery disease, obesity, diabetes, and dementia with significant difficulty caring for himself. He uses a wheelchair at baseline and does not meaningfully communicate or interact with others. His power of attorney and family states that the patient is not to undergo invasive procedures, cardiopulmonary resuscitation, or intubation in the event of a cardiac arrest or respiratory failure. His temperature is 98.3°F (36.8°C), blood pressure is 167/105 mmHg, pulse is 92/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals a disheveled man. He is aphasic and does not move his right upper or lower extremities. He has 4/5 strength in his left upper and lower extremities which is his baseline. He does not follow commands and only withdraws to pain. A computed tomography (CT) scan of the head and CT angiography of the head and neck reveal a left middle cerebral artery occlusion. Which of the following is the most appropriate management for this patient?

A 68-year-old female presents to the Emergency Department wi…

A 68-year-old female presents to the Emergency Department with lower extremity weakness, cramping, and pain that occurs whenever she goes for a walk. The pain seems to subside if she rests, but lately she has noticed that the weakness and cramping in her legs are getting worse. Her past medical history is notable for hypertension, hyperlipidemia, and chronic kidney disease. She smokes 1 pack of cigarettes a week for the past 30 years. Her temperature is 98.4°F (36.9°C), blood pressure is 150/68 mmHg, pulse is 66/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam reveals the finding in the image below. Her lower extremities are smooth and cool to the touch. Her motor function is intact and she can plantar and dorsiflex. Which of the following is the most likely finding upon diagnostic evaluation of this patient?

A 10-month-old boy presents to the emergency department at 1…

A 10-month-old boy presents to the emergency department at 10 pm with a history of three days of low-grade fever and rhinorrhea, followed by one day of barking cough and difficulty breathing. The child’s cough has been progressively getting worse.  He is eating poorly, but there is no emesis or diarrhea. There is no significant past medical history, and the mother states all his vaccinations are up-to-date. No one else in the household is currently ill.  The child lives with his mother and a 2-year-old sister and attends day care. On physical exam he has a temperature of 101.3°F, elevated respiratory rate of 48/min, and normal heart rate and blood pressure. On lung exam, there are subcostal inspiratory muscle retractions and on auscultation, a high-pitched inspiratory stridor is present. The patient’s symptoms are most likely caused by which of the following conditions?