A 15-year-old sustains a gunshot wound to the right lower abdomen. In the trauma bay: HR 108 bpm, BP 112/68 mmHg. Abdominal exam shows peritoneal penetration on local wound exploration. There is no peritonitis on exam. CT abdomen/pelvis shows the trajectory traverses the peritoneal cavity. What is the most appropriate definitive management decision?

A 2-year-old male with phenylketonuria (PKU) on a low-phenylalanine diet has been refusing his medical amino acid formula for 3 months. His plasma phenylalanine level is 1,920 μmol/L (therapeutic target: 120–360 μmol/L). The metabolic team discusses therapeutic options. Which agent is most appropriate to evaluate in this patient and what is its mechanism?

A 5-year-old with Type 1 diabetes is being treated for moderate DKA (pH 7.18, glucose 410 mg/dL). She is receiving an insulin infusion at 0.1 units/kg/hr and IV fluid replacement. At hour 7 of treatment, she develops a new headache and becomes increasingly difficult to rouse. HR is 54 bpm and her pupils are unequal. What is the most appropriate immediate intervention?

A 10-year-old with newly diagnosed Crohn disease has terminal ileitis and ascending colon involvement confirmed on colonoscopy and MR enterography. CRP 72 mg/L, albumin 2.6 g/dL. The family is strongly opposed to corticosteroids. Which induction therapy has the strongest evidence in pediatric Crohn and is preferred by current guidelines as an alternative to steroids?

A 15-year-old with new-onset Type 1 diabetes presents in DKA: glucose 540 mg/dL, pH 7.11, HCO3 5 mEq/L, Na 131 mEq/L, K 3.1 mEq/L, anion gap 31. He has received a 10 mL/kg 0.9% NS bolus over 1 hour. The team is ready to initiate the insulin infusion. What should happen first before starting insulin?

A 14-year-old presents with a 6-month history of episodic severe headaches, profuse diaphoresis, and palpitations. BP today is 198/118 mmHg. She has a family history of medullary thyroid cancer in her mother. Plasma free metanephrines and normetanephrines are markedly elevated. The intern orders metoprolol 1 mg/kg PO for blood pressure control. What is the most serious concern with this order?

George and Kevin are at a concert in downtown Mondaleville. Kevin has a particular condition that causes his bones to break easily, though George is not aware of this fact. While dancing to the music, George jumps on Kevin’s back without Kevin’s permission, which ultimately leads to Kevin experiencing a fractured vertebra. George feels incredibly bad about what happened and sincerely states that he was never trying to hurt Kevin. Does Kevin have an actionable claim against George for battery? 

A 6-year-old boy with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is brought to the emergency department with vomiting and poor oral intake for the past 24 hours due to a viral illness. His parents report increasing lethargy and difficulty waking him this morning. Vital signs are: HR: 135 beats/min BP: 90/52 mmHg RR: 24 breaths/min Temperature: 37.8°C Laboratory studies reveal: Glucose: 38 mg/dL Serum bicarbonate: 18 mEq/L Ammonia: normal The child is somnolent but arousable. Which of the following is the most appropriate immediate management?

An infant who experiences recurring rejection by primary caregivers and displays little emotional response to them—treating caregivers much like strangers—is demonstrating which attachment style?

According to the GRIEV_ING protocol for delivering news of a death, what language should the EMT use during the “Verify” step?