A 55 year old male with PMH of HTN reports malaise and cough for 5 days.  Patient is not sure if he has had any fever, but reports some chills.  Patient reports the cough is slightly productive, but not sure of the sputum type.  Patient reports he also has nasal congestion, which has improved somewhat.  Patient reports the cough is keeping him up at night and his lower chest and abdominal muscles hurt with the cough.  Patient also reports some shortness of breath with exertion, but denies exertional chest pain.  Patient denies nausea, vomiting, diarrhea or leg swelling.  On exam, patient is well developed overweight male, in no apparent distress.  Trachea midline, no JVD.  Chest expansion is symmetric, anterior:lat diameter is 2:1.  On auscultation, lungs with rales in middle field of the Rt lung heard posteriorly, but no wheezing or rhonchi.  S1 and S2 with no murmurs, rubs or gallops.  No leg edema.  The rest of the exam is unremarkable.  VS: BP: 135/95 sitting Rt arm; HR: 105 bpm; R: 20 breath per minute; T: 100.7F oral; Pulse Ox: 95% on Room Air. Please provide differential diagnosis for this presentation (list at least 5) AND what imaging would be indicated for this case.

A 30 year old male with no PMH reports shortness of breath since 1 hour ago.  Patient reports the onset was sudden and started while he was walking to his car from the store.  Patient denies tobacco use, fever, chills, nasal congestion, cough, chest pain, abdominal pain, nausea, vomiting, diarrhea or leg swelling.  On exam, patient appears tall and thin, in mild respiratory distress and tachypneic, but speaking full sentences.  Trachea midline.  Chest expansion is symmetric, anterior:lat diameter is 2:1.  On auscultation, decreased lung sounds on Lt side, the rest of the lungs with no wheezing, rales or rhonchi.  S1 and S2 with no murmurs, rubs or gallops.  No leg edema.  VS: BP: 145/95 sitting Rt arm; HR: 105 bpm; R: 22 breath per minute; T: 98.6F oral; Pulse Ox: 92% on Room Air. Please provide differential diagnosis for this presentation (list at least 5) AND what imaging would be indicated for this case.

A 55 y/o female patient with PMH of hysterectomy, cholecystectomy and appendectomy reports 1 and a half day history of worsening abdominal distension and pain.  Patient also reports associated nausea and vomiting 3 times.  Patient reports that last vomiting episode was of green material.  Patient reports 1 episode of diarrhea 1 day ago at the start of the symptoms, but has not been able to pass gas since then.  On exam, patient appears pale. Abdomen is distended, absent bowel sounds, hyper resonant on percussion, diffuse tenderness with no rebound.  VS: BP: 145/95 mmHg Lt arm supine, HR: 100 bpm, T: 98.8F oral, RR: 20 bpm. Based on the information provided, please give 5 differential diagnosis with your most likely differential listed first AND what is the most appropriate initial imaging to order.

A 55 year old male with PMH of HTN reports malaise and cough for 5 days.  Patient is not sure if he has had any fever, but reports some chills.  Patient reports the cough is slightly productive, but not sure of the sputum type.  Patient reports he also has nasal congestion, which has improved somewhat.  Patient reports the cough is keeping him up at night and his lower chest and abdominal muscles hurt with the cough.  Patient also reports some shortness of breath with exertion, but denies exertional chest pain.  Patient denies nausea, vomiting, diarrhea or leg swelling.  On exam, patient is well developed overweight male, in no apparent distress.  Trachea midline, no JVD.  Chest expansion is symmetric, anterior:lat diameter is 2:1.  On auscultation, lungs with rales in middle field of the Rt lung heard posteriorly, but no wheezing or rhonchi.  S1 and S2 with no murmurs, rubs or gallops.  No leg edema.  The rest of the exam is unremarkable.  VS: BP: 135/95 sitting Rt arm; HR: 105 bpm; R: 20 breath per minute; T: 100.7F oral; Pulse Ox: 95% on Room Air. Please provide a reading for the following image (same format as previously): 

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What is the NFPA standard for fire alarm and signaling code?

Battalion Chief 2 arrives on the scene and assumes initial command of a structure fire at 123 Fifth Avenue SW. How should the chief announce status as incident command?

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