69y.o. female with no past medical history, complaining of right sided neck pain for five days.  Patient was seen for the same at another hospital three days ago and diagnosed with musculoskeletal pain, and muscle spasm after a negative work up.  Patient was sent home with ibuprofen, valium and reglan.  She states she has not felt relief with the pain medications. Patient is accompanied by two family members.  Upon further questioning, the family states that the patient is very tired and has been sleeping constantly for the past three to four days. She has also had an unsteady gait and fallen several times over the same period of time. Patient denies fever, and was in a normal state of health before the neck pain began.  She did hit her face once when she fell two days ago without loss of consciousness.  Denies nausea, and vomiting.  No focal neurologic complaints.  No numbness or weakness in the face or extremities. PE showed normal vitals and normal exam except:  CN 2-12 intact, motor 4/5, reflexes normal, unable to evaluate gait or finger to nose, heel to shin, because patient kept falling asleep during exam. A non-contrast Head CT was done. What is your diagnosis?

Case provided by Dr. Williams, EM-4 

 84 year old female with PMHx of ovarian ca, recently started on chemotherapy, presented to ED with one day history of left lower extremity swelling.  Swelling started at the calf earlier in the day and rapidly spread up to involve the thigh.  Patient denied any trauma to the leg.  She denies pain, but states that the skin of the leg feels tight.  There was no history of fever or chills.  Denied chest pain or difficulty breathing.  Exam was significant for LLE swelling and discoloration involving entire leg; non-tender, not hot; non – pitting; + strong pedal pulses bilaterally. What is your diagnosis?

 A 65 year old female with osteoporosis presents to the ED after a high speed MVC: restrained passenger with airbag deployment. Unable to ambulate at scene complaining of severe pelvic and lower abdominal pain. She was diagnosed with an unstable pelvic fracture on x-rays. She remained persistently tachycardic despite pain control and fluid resuscitation. She subsequently developed a fever. Upon examination of the urine you notice gross blood. A Foley catheter is inserted into the urethra and an x-ray retrograde urethrogram is negative. The catheter is then inserted into the bladder and the following study it performed. What is your diagnosis?