A 32-year-old man is stabbed in the left chest and presents to the emergency department in distress. His pulse is 130/min, blood pressure is 70/50 mm Hg, and respiratory rate is 39/min. The stab wound is in the left fifth intercostal space in the midaxillary line. On examination his trachea is deviated to the right, jugular veins are distended bilaterally, and he has absent breath sounds and hyperresonance to percussion on the left side. Subcutaneous emphysema is palpated on the left thoracic wall. What is the best next step in management?

A. Needle thoracostomy
B. Chest tube thoracotomy
C. Pericardiocentesis
D. Surgical exploration
E. Diagnostic peritoneal lavage

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A 60-year-old man with recurrent bacterial sepsis is hospitalized in order to receive intravenous antibiotics. He is started on his fourth course of broad-spectrum antibiotics within the past month. Three days into the admission, his nurse notes that his venous access is oozing blood. Laboratory tests reveal a prolonged prothrombin time, a prolonged partial thromboplastin time, and a normal platelet count. Which of the following coagulation cofactors would be deficient first in this patient?

A. Factor II
B. Factor V
C. Factor VII
D. Factor VIII
E. Factor XI
F. Factor XII

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The best, least biased, article about the Health Care situation that I’ve seen in years. Worth reading from beginning to end.

Please Click here for the Article

The ultimate success of Obamacare might depend on a cultural change among doctors and patients, a national realization that more care isn’t better care. “We’ve got this ethos that the best doctors do everything under the sun and rule out every zebra,” Emanuel says. “And hey, they get paid more to do it. But we’ve got to change all that.”

A 30-year-old woman presents to a primary care physician for a new patient visit. She reports recurrent episodes of pneumonia, bronchitis, and otitis over the past 4 years. Although her vaccinations were up to date, she developed tetanus following a foot laceration last year. Her lymph nodes and tonsils are enlarged. Laboratory testing reveals low IgG, IgA, and IgM levels. After referral to a hematologist, who rules out other acquired and genetic causes of her hypogammaglobulinemia, she is diagnosed with common variable immunodeficiency. This woman is at the highest risk of developing which of the following condition?

A. Cardiovascular disease
B. Lymphoma
C. Miscarriage
D. Renal disease
E. Splenic autoinfarction

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A mutation in the elongation factor EF1-?, which is essential for protein synthesis, causes it to have a higher affinity for GDP than normal. This decreases the growth rate of the cells due to a decrease in protein synthesis. A secondary mutation in the cells increases the growth rate back toward normal. Which of the following is the secondary mutation?

A. Decreased affinity of elongation factor EF1-? for guanosine triphosphate
B. Decreased affinity of elongation factor EF1-? for guanosine triphosphate
C. Elimination of EF1-?
D. Elimination of EF1-?
E. Increased affinity of elongation factor EF1-? for the mutant EF1-?

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The First Aid Team is looking for motivated students passionate about medical education and technological innovation to join the Team! Send an email with a résumé to us at first.aid@ucla.edu

The Job

• One year commitment to working with members of the First Aid Team on projects involving new methods for enhancing medical education and Board preparation.
• Independently research issues affecting students studying for the Boards and contribute to the First Aid/USMLERx Blog.

The Perks

• Potential authorship credit in First Aid for the USMLE Step 1.
• Generous stipend.
• Opportunity to work with First Aid authors and develop relationships for future opportunities.

The Applicant

• Interested in medical education and in helping fellow students.
• Comfort with Microsoft Office (Word, Excel, PPT), Acrobat, and Photoshop.
• Background in engineering or technology a plus; up-to-date with new technologies.
• Ability to synthesize multimedia documents.
• Organized, dependable, and able to work with a team.

Click the image for the recipe

Contents:

- PREPARING FOR THE ERAS 2010 APPLICATION SEASON
- ERAS TOKEN FEE INCREASES
- MANDATORY USE OF DIGITAL PHOTOGRAPH UPLOAD FEATURE
- ERAS 2010 REPEAT APPLICANTS CAN REUSE LETTERS OF RECOMMENDATION
- ERAS SUPPORT SERVICES AT ECFMG WORKING WITH INTERNATIONAL MEDICAL SCHOOLS TO IMPLEMENT ELECTRONIC SUBMISSION OF SUPPORTING DOCUMENTS

Click here for the ECFMG Reporter’s Latest Edition