This chapter describes a case of a 42-year-old male with lower back pain, who is a current IV heroin user. The patient reports feeling generally weak, but denies focal weakness, incontinence, or sensory loss. The secondary survey reveals lumbar tenderness, diminished rectal tone, and a 3 cm abscess with surrounding erythema on the skin at the right inner thigh. The patient is diagnosed with spinal epidural abscess and is started on broad-spectrum IV antibiotics, undergoes incision and drainage of the abscess, and receives a spinal MRI. The chapter also highlights important pearls, including the fact that Staph aureusis the most commonly involved bacteria, and MRI imaging is the gold standard with a sensitivity and specificity greater than 90%.

A patient presents for shortness of breath due to a pericardial effusion, with tamponade physiology, requiring emergent interventions.

This chapter presents a case of a 50-year-old male with community-acquired pneumonia triggering sudden worsening of underlying hyperthyroidism. The case highlights the identification of hyperthyroidism despite several vital sign changes that could be due to either his pneumonia or underlying hyperthyroidism, as well as medical intervention to treat hyperthyroidism without worsening the disease process.

The chapter describes the case of a 55-year-old female with left-sided headache and vision changes, who presents with acute-onset left supraorbital headache along with severely diminished vision in her left eye. The physical examination reveals injected conjunctiva on the left, a firm left globe compared to the right, left pupil mid-dilated, nonreactive, and left eye visual acuity of 20/200. The patient is diagnosed with acute angle-closure glaucoma, which is an ophthalmologic emergency. Critical actions include rapid identification of the diagnosis, brisk administration of a combination of medicines aimed at decreasing intraocular pressure via different mechanisms, and emergent ophthalmology consult. The chapter provides several pearls, including the importance of thorough eye examination including intraocular pressures, early administration of medications to lower intraocular pressure, and consideration of relative contraindications for glaucoma medications.

The chapter describes a case of a 61-year-old man with epigastric pain and nausea. The patient had a history of type 2 diabetes and hypertension. He was pale, clammy, and in moderate distress. The primary survey revealed cool and clammy skin, normal capillary refill, and increased respiratory rate. The patient was given peripheral IV line access, CBC, BMP, LFT, cardiac enzymes, and PT/PTT labs. He was also given a 500 mL NS bolus and a cardiac monitor was set up. The patient was diagnosed with inferior wall myocardial infarction with right ventricular involvement. The critical actions included obtaining EKGs, recognizing the myocardial infarction pattern, IV access and fluid bolus, aspirin administration, avoiding nitroglycerin and morphine administration and activating cardiology consultation. The chapter provides pearls on the treatment of inferior wall myocardial infarction and the use of drugs that decrease preload. Reperfusion therapy was recommended for both inferior and right ventricular myocardial infarction.

This chapter presents a case of an unstable trauma patient in an oral boards review format. A pedestrian struck by a motor vehicle has pelvic fractures and open lower extremity fractures resulting in hemorrhagic shock that requires rapid treatment for stabilization.

A 7-year-old boy presents with diffuse colicky abdominal pain, emesis, and bloody diarrhea. He also complains of leg pain while walking. The patient appears uncomfortable due to pain, lying supine on the stretcher. The primary survey reveals no respiratory distress, no cyanosis, and good peripheral pulses. The secondary survey shows periarticular swelling and tenderness in bilateral knees and ankles, palpable purpura on bilateral lower extremities and buttocks, and hemoccult-positive rectal exam. The diagnosis is Henoch–Schönlein purpura with jejuno-ileal intussusception. Critical actions include fluid resuscitation, laboratory and urine testing, abdominal x-ray, abdominal ultrasound, pain management, and surgery consult. The overall prognosis is excellent, although long-term sequelae can occur in children with bowel perforation or more extensive renal involvement. Admission to the hospital may be appropriate in children with concerning symptoms.

Sepsis in infants can present in a variety of ways, including but not limited to fever, lethargy, altered mental status, respiratory distress and poor feeding. An ill-appearing infant should be considered septic until proven otherwise, by obtaining blood, urine, and cerebrospinal fluid samples to be sent for analysis. Broad-spectrum antibiotics should be provided early, and IV fluids should be given, especially if there is concern for septic shock. Infants with sepsis should be admitted to the hospital for monitoring and continued management.

The chapter discusses the evolution and current practices of oral examinations in emergency medicine certification boards, focusing on ABEM and AOBEM. It details the transition from traditional simulations to technology-enhanced formats and the impact of the COVID−19 pandemic on testing procedures. The chapter highlights the structured interview as a new assessment method and provides insights into examination content and scoring criteria. It explores the upcoming changes in certification exams and offers strategies for candidates to optimize their performance in these simulation-based assessments. The chapter aims to prepare candidates for the board certification process by providing detailed information on examination formats, procedures, and scoring rubrics.

This chapter covers the immunophenotype of acute myeloid leukemia (AML) with RUNX1::RUNX1T1. In addition to RUNX1T1, rare cases have RUNX1T3 as the fusion partner with RUNX1, and their immunophenotype is also described. The major differential diagnosis is mixed-phenotype acute leukemia and the distinction is highlighted.

The chapter describes the case of a 45-year-old male with stage 3 HIV who presents to the ED with fever, shortness of breath, pleuritic chest pain, and nonbloody diarrhea. The patient exhibits tachycardia, hypoxia, and a warm, diaphoretic appearance. Initial actions include oxygen supplementation, IV fluids, and labs. The patient is diagnosed with HIV pneumonia, likely Pneumocystis jirovecipneumonia (PCP), and is treated with antibiotics and steroids. Early recognition of fever and hypoxia, along with respiratory isolation, is critical to prevent sepsis. Tests ordered should include CBC, electrolytes, liver function tests, urinalysis and culture, blood cultures, and CXR. Focal infiltrates suggest bacterial pneumonia, while a diffuse interstitial or perihilar, granular pattern on CXR is associated with PCP. Steroids should be given to patients with a partial pressure of arterial oxygen <70 mmHg or an alveolar–arterial gradient of >35 mmHg.

Ludwig’s angina is often caused by a dental infection and can potentially develop into an airway emergency. Patients may present with a toothache, submandibular swelling, or elevation or protrusion of the tongue. The principles of early antibiotics, close airway monitoring, and surgical consultation are important in the early management of Ludwig’s angina. In some cases of Ludwig’s angina the airway can become compromised very quickly. ED providers and surgical consultants should be prepared with advanced airway strategies in these patients. Although imaging may be helpful in the diagnosis of Ludwig’s angina, ultimately this is a clinical diagnosis.

Nationally, chest pain is one of the most common presenting chief complaints for emergency department visits. The differential diagnosis should be broad and interpreted through the lens of a thorough history and physical exam. Sympathomimetic drugs, such as cocaine, can serve as both an acute cause of pain due to associated cardiac ischemia resulting from coronary vasospasm, and an independent risk factor for development of coronary artery disease in the setting of prolonged use. Rapid acquisition of an EKG is vital to identify potential acute cardiac ischemia, and aspirin remains a mainstay of treatment. Due to potential unopposed α-agonism, β-blockers are typically avoided for hypertensive crisis in cocaine chest pain, and one should consider alternatives, such as IV phentolamine.

This is a case of congenital critical coarctation of the aorta in a neonate presenting with shock due to the closing of the ductus arteriosus. Neonates try to increase systolic blood pressure from the outflow tract obstruction caused by the coarctation of the aorta, leading to symptoms of heart failure. When the ductus arteriosus closes, that leads to decrease in systemic flow and shock in the patient. Important actions include recognizing shock, initiating prostaglandin, and consulting cardiology.

Geriatric patients can present to the emergency department with confusion due to intracranial injuries, including atraumatic subdural hematoma among other causes. Physicians should perform a thorough history and physical exam when evaluating patients with altered mental status in an attempt to derive the etiology of their presentation.

Pediatric patient with sickle cell anemia presenting with fever and rash, with associated URI symptoms found to have aplastic anemia secondary to presumed parvovirus B19 infection. The patient requires emergent blood transfusion and broad-spectrum antibiotics for right-sided pneumonia on chest x-ray. The patient is ultimately admitted to the hospital with a pediatric hematology consultation.

This chapter describes a case of a 45-year-old male with stage 3 HIV who presented to the ED with fever, shortness of breath, pleuritic chest pain, and nonbloody diarrhea. The patient was diagnosed with HIV pneumonia, likely Pneumocystis jiroveci pneumonia(PCP), and was treated with antibiotics, steroids, oxygen supplementation, and IV fluids. The chapter emphasizes the importance of recognizing the symptoms of pneumonia in HIV patients and providing early treatment to prevent sepsis. The chapter also provides guidelines for diagnostic tests and highlights the significance of CD4 counts in the development of pulmonary disorders in HIV patients.

Flow cytometry plays an important role in the diagnosis of B-cell lymphomas/leukemias. The identification of aberrant B cells by flow cytometry supports a neoplastic or clonal process. In this chapter, we focus on mature B-cell lymphomas/leukemias and describe the common approaches used in flow cytometry for identification of abnormal B cells as well as challenges and pitfalls associated with these approaches. Normal B-cell differentiation will be discussed first, which is fundamental for understanding cell of origin and identifying abnormal B cells in different subtypes of lymphomas.