A 79 year old female with a history of RA and parkinson's dx presents to the ED with a syncopal episode. She fell from a standing height and hit the back of her head. She was unable to stand and called EMS via medical alert signal when she awoke. She is complaining of midline neck and head pain that is worse when she rotates her neck. She does not have any focal deficits. She was not intoxicated. She has normal mental status. GCS= 15. She has pain when palpating midline C2-C4. She does not have any long bone injuries, but has rib pain and tenderness on the left side. Being an astute ED resident you order a CT of the neck. What do you see? (hint look at C2)

 A 12 year old female presents to the ED with a rash over her hands, lower extremity, and face and lips. The patient recently had a URI and was treated by her pediatrician with Azithromycin. Her URI symptoms resolved 2 days after starting the medication. She then developed the rash. She has not eaten after getting the rash because of pain in the mouth. The rash is not itchy. There are multiple lesions on lips, none in the vaginal, rectal or ocular areas.  No one else has a similar rash in her family and she has not traveled outside of the country. She has no other medical problems. What is your diagnosis?

Image provided by Dr. Volfson, EM Chief Resident