2yo M previously healthy with reported 3 weeks of diarrhea a | Figure 1

2yo M previously healthy with reported 3 weeks of diarrhea and emesis. Clinically stable. No emesis or diarrhea episodes since admission to hospital: Photo 1: diaper of patient taken by mother. Photo 2: contents of reported emesis. Of note, patient had KUB in ED that showed small unidentifiable metal object at ileocecal junction.

Patient is a 35-year-old male who suffers from obesity hypertension currently on clonidine patches, and just recently started Ozempic at .5 mg a week; also has hypogonadism and is on 100 mg weekly testosterone. Patient came in complaining of symptoms related to GERD. RN said that he tried taking lansoprazole with some relief; however, patient reports extreme bloating and the feeling of a large gas bubble stuck in the stomach. Patient also reports emesis of food eaten 12 hours prior and his blood pressure pills not digested in it. Frequent diarrhea about four times daily since starting Ozempic. Patient has also reported trying his partner's creon with no relief. Upon examination, the abdomen is distended and non-tender. The patient is clearly uncomfortable. Blood pressure is 144/96; temp is normal; respirations are normal. Lungs are clear bilaterally. Glucose is 112. CBC and CMP within normal limits.

Summary of radiographic signs of intussusception (a common cause of small bowel obstruction in 1st two years of life):

  1. Target sign: a mass in RUQ, often has a target appearance (but subtle!)
  2. Crescent sign: caused by the intussuscepting lead point (the "intussusceptum") that protrudes into the gas-filled pocket of colon
  3. Absence of subhepatic angle
  4. Bowel obstruction Rest of the story: this was a 12-month-old toddler, who presented with emesis and abdominal pain. Child was stabilized and admitted for radiologic reduction.

Gastrografin enema in one year-old male. History of reflux as an infant, chronic constipation. Now with undigested food in feces. Patient fell from 75% percentile for weight when exclusively breastfed to 50% after introduction of complementary solid food. What was the indication for the test? What do you see? What would you do next?

4-year-old girl with history of recurrent episodes of epigastric pain for 2-months presenting with 2-days of epigastric and right lower quadrant pain in the setting of fever to 102˚F and non-bloody/non-bilious emesis. Parents deny rash, shortness of breath, diarrhea, difficulty with urination; admit to fever, abdominal pain, emesis. BMP revealed Na 135; CBC showed WBC 25.5 (84% neutrophils); and UA is negative.
Patient underwent ultrasound imaging, but the appendix was not visualized. MRI imaging shown. What is the differential diagnosis? What would be your plan for the patient?

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?