A tubo-ovarian abscess (TOA) is a serious infection of the female upper genital tract affecting the ovaries. It is typically a sexually transmitted disease most commonly caused by Chlamydia trachomatisor Neisseria gonorrhoeae. Patients with a TOA may complain of lower abdominal pain, pelvic pain, or fever. The history, urogenital examination (typically demonstrating vaginal discharge, cervical motion tenderness, adnexal tenderness), and pelvic ultrasound collectively lead to the diagnosis of tubo-ovarian abscess. The mainstay of treatment of TOA is admission with IV antibiotics and pain control. Consider gynecology consultation. In some cases where IV antibiotics have failed, drainage of the abscess must be considered.

This chapter demonstrates an important orthopedic and infectious emergency that all emergency physicians should recognize. This material covers septic arthritis with a specific focus on the knee, giving guidance on lab result interpretation and antibiotic choices. In addition, this chapter reviews a procedure that all emergency medicine physicians should be able to perform, an arthrocentesis, and requires joint x-ray interpretation.

A case to prepare the reader for the emergency medicine oral boards examination. it discusses appropriate management of tension pneumothorax, including case presentation, key actions, and clinical reasoning.

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and mantle cell lymphoma (MCL) are the two prototypical CD5-positive B-cell neoplasms. Both are characterized by CD5 expression, and distinguishing one from the other is essential when rendering a diagnosis. Therefore, these two entities are discussed together. The immunophenotype of typical and atypical CLL/SLL is described, along with minimal residual disease evaluation of CLL/SLL by flow cytometry. For MCL, the immunophenotype of the classic, leukemic non-nodal, and cyclin D1-negative subtypes is discussed. The differential diagnosis between CLL/SLL and MCL, as well as their distinction from reactive CD5+ B cells and other CD5+ B-cell lymphomas/leukemias, is also addressed.

This chapter discusses a case of a 53-year-old female with a stab wound to the chest and dyspnea. The patient presented with severe respiratory distress, decreased breath sounds on the right side, and unstable vitals. The diagnosis was a tension pneumothorax, which requires prompt management. Treatment involves finger thoracostomy or emergent needle decompression followed by thoracostomy tube. Delay in treatment can lead to cardiac arrest. The chapter emphasizes the importance of a high level of suspicion for tension pneumothorax in the presence of decreased or absent breath sounds on the affected side and the need for immediate treatment without waiting for imaging or lab studies.

This case reviews the complications of an inferior myocardial infarction that can cause third-degree block and significant hemodynamic instability. Discussion focuses on immediate stabilization, including volume resuscitation, atropine, pressors, and transcutaneous pacing. Definite management with interventional cardiology should promptly follow for percutaneous coronary intervention and transvenous pacing as needed.

This case reviews a middle-aged male with liver cirrhosis and ascites who presents with abdominal pain. Following a paracentesis, he is diagnosed with spontaneous bacterial peritonitis, administered antibiotics, and admitted to the hospital.

This chapter presents a case of a 32-year-old female with acute mountain sickness. The case highlights the importance of context when investigating symptoms as there is a significant overlap between acute mountain sickness and other less dangerous etiologies such as hangover, as well as appropriate treatments for acute mountain sickness.

A 48-year-old male is brought in for emergency evaluation from the local correctional facility. He complains of chest pain, shortness of breath, and a cough. He is tachycardic, tachypneic, hypoxic, febrile, and borderline hypotensive. He is alert but diaphoretic and leaning forward in the gurney, with increased work of breathing. As the treating physician, you learn that he has AIDS with a CD4 count of 94. Your quick exam reveals a rapid heart rate, bilateral rales, and white plaques in the posterior oropharynx. As you generate your differential diagnosis, you simultaneously begin to address the patient’s abnormal vital signs. You start a 1 L bolus of normal saline, place the patient on a nonrebreather face mask at 15 L per minute, and treat his fever with acetaminophen. Because of the patient’s fever, a pulmonary infection is highest on your differential. Given the patient’s compromised immune system and incarcerated status, you realize the need to do more than treat bacterial pneumonia. While starting antibiotics, what are your next moves?

Anaphylaxis is a life-threatening allergic reaction that must be treated immediately to prevent morbidity and mortality. In this chapter, learn how to recognize and treat anaphylaxis and prepare yourself to save a life!

This chapter delineates the case of a hypothermic pediatric patient who presents to the emergency department after drowning in cold water. The objective is to review the emergency management of a patient who experiences a cold-water immersion event, with a focus on initial assessment and treatment as well as guidance on how to rewarm a hypothermic patient. The case is formatted as an interactive, real-life scenario to help the learner retain information and successfully prepare for the emergency medicine oral boards.

This chapter described the immunophenotypic characteristics of different subtypes (hypergranular and microgranular) and different patterns (A to D) of acute promyelocytic leukemia (APL). APL with variant RARA translocations (involving partners other than PML) and cases with translocations involving RARB or RARG are also discussed. The differential diagnosis includes normal versus neoplastic promyelocytes, microgranular APL versus acute monocytic leukemia, and APL versus other subtypes of AML with an APL-like immunophenotype.

This case details a 40-year-old male presenting with 2 days of gradually worsening flank pain. Within this chapter we review past medical history, physical exam, lab results, and imaging to approach a diagnosis. Treatment and subsequent medical management will also be assessed. The chapter culminates in a clinical summary including tips and tricks for approaching similar cases during the oral boards.

In this chapter, we focus on the myelomonocytic lineage, discussing its normal and abnormal immunophenotypes. For minimal residual disease (MRD) evaluation, the primary focus is acute myeloid leukemia (AML); however, the similar principles apply to MRD evaluation for all other myeloid neoplasms, including myelodysplastic syndrome (MDS), myelodysplastic/myeloproliferative neoplasms (MDS/MPN), and myeloproliferative neoplasms (MPN). In our daily practice, similar flow cytometry panels are used for MRD evaluation across all myeloid neoplasms. Two approaches are used for MRD evaluation by flow cytometry: different from normal (DfN) and leukemia-associated immunophenotype (LAIP). This chapter covers both approaches. For DfN, we discuss in detail the characteristics of normal and abnormal immunophenotypes across three maturation stages: CD34+, CD34-CD117+, and monocytes. In combination with LAIP, immunophenotypic shifts and their associated mechanisms in AML are discussed. Panel design, gating strategies and reporting for flow cytometry MRD are also included.

This chapter describes the normal maturation patterns of T and NK cells. Approaches and challenges in identifying their abnormal counterparts are discussed in detail.

The chapter describes the case of a 10-day-old male with shortness of breath, poor feeding, and lethargy. The patient exhibits respiratory distress, intercostal and subcostal retractions, and a systolic murmur. Initial actions include oxygen supplementation, IV placement, and labs. The patient is diagnosed with critical aortic coarctation, which is dependent upon a patent ductus arteriosus to maintain blood flow to the body. Prostaglandin E1 administration and cardiology consultation are critical actions. Congenital heart disease should be considered in any newborn in shock or severe distress, and early recognition and intervention are important. Differential blood pressure and oxygen saturation can be clues to congenital heart disease.