Issue 11:4

Clinical Decision Making: Sickle Cell Crisis with Acute Chest Syndrome

Ryan Adkins, DO*

DOI: https://doi.org/10.5070/M5.53173 Issue 11:4[mrp_rating_result]
By the end of this clinical decision-making case, learners will be able to: 1) demonstrate familiarity with a case, 2) identify focused historical and physical exam findings in ACS, 3) develop a differential diagnosis for chest pain in a sickle cell patient, 4) select and interpret appropriate diagnostic studies, 5) initiate ED management including oxygen, antibiotics, and pain control, 6) recognize when to consult hematology and consider transfusion, 7) appropriately disposition the patient and communicate a transition of care, and 8) explain the pathophysiology of ACS.
Current IssueCertifying Exam CasesClinical Decision-Making

Physical Wellbeing Scavenger Hunt

Walker Plash, MD* and Grace Lagasse, MD*

DOI: https://doi.org/10.5070/M5.53258 Issue 11:4[mrp_rating_result]
By the end of this session, the learner will be able to: 1) implement basic ways to improve sleep quality, 2) avoid common pitfalls in diet and nutrition, 3) incorporate more physical activity into their lives.
Current IssueSmall Group LearningWellness

Physical Frailty and End-of-Life Care Small Groups

Candace Leigh, MD* and Kevin Watkins, MD*

DOI: https://doi.org/10.5070/M5.53060 Issue 11:4[mrp_rating_result]
At the end of this module, learners should be able to: 1) recognize and classify end-of-life trajectories, 2) define physical frailty, including risk factors, prevalence and prognosis in ED patients, 3) develop a differential diagnosis and diagnostic and treatment plan for a patient with metastatic cancer presenting with fatigue, constipation, labile mood, and diffuse osseous pain, 4) review Medicare Hospice Benefit eligibility, 5) understand the differential diagnosis and medical management of chemotherapy-related nausea, 6) discuss the assessment and management of dyspnea in end-of-life patients, and 7) review how to estimate and communicate prognosis using practical timeframes.
Current IssueSmall Group LearningSocial Determinants of Health
Intentional Pencil Ingestion. CT axial. JETem 2026

Intentional Pencil Ingestion – A Case Report of a Sharp Ingested Foreign Body

Francis Gan, MD*, Nathan Mercado, MD*, Abhijnya Gowder^, Daniel Ng, MD*^ , Sassan Ghassemzadeh, MD* and John Costumbrado, MD, MPH*^

DOI: https://doi.org/10.5070/M5.53005Issue 11:4[mrp_rating_result]
Computerized tomography (CT) of the abdomen and pelvis two days after the ingestion of the pencil revealed a hypodense foreign object measuring 7.9 cm (blue arrows) in the lumen of the distal ileum. The images obtained demonstrate that the object progressed past physiological strictures within the gastrointestinal tract such as the esophagus and stomach; however, it had yet to progress through the ileocecal junction. Ingested foreign bodies carry a high risk of obstruction and perforation at these physiological stricture points. A repeat CT scan six days later showed that the pencil (yellow arrow) had progressed to the distal transverse colon.
Current IssueAbdominal/GastroenterologyVisual EM