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Here you will find information regarding rotation schedules, academic resources, wellness and facts about our program and residents. Check out our bios and photos. Please also visit the Emergency Department's official residency website. This site is intended for Mount Sinai EM residency purposes only, and no information on these pages is intended or should be construed as medical advice. Read more.

Tall R in V1 Differential?

My CCU attending asked me to, if nothing else, remember 3 causes of a tall R wave in V1. In my diligence I have indeed remembered nothing else. What’s in your differential?


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Woke Up with Weak Legs

30 y.o. M PMHx hyperthyrodism, who presents c/o b/l leg weakness since this AM. Pt states he awoke with the symptoms and was unable to stand. Feels that his weakness is located in his thighs. Had similar episode 4 days ago, went to OSH and symptoms had resolved. Denies numbness, other neuro complaints, changes in bowel or bladder, trauma, history IVDU or CA, pain, fever, N, V, SOB.
meds: propylthiouracil, propanolol

Exam is significant for 1/5 strength to BL proximal  LE, with 5/5 strength distally. Sensation grossly intact. Somewhat hyporeflexic to lower extremities.

What tests would you order? What could be in the differential?

Cxr Adequacy

CXR’s can be misleading, some common points to be aware of:

Erect vs supine (fluid layering):


AP view can magnify the heart (PA vs AP):


Rotation – are the spinous processes centered between the medial edges of the clavicles? Note how heart width changes with rotation.


Penetration – vertebral bodies should be just visible behind the heart

1penet 1penet2

Inspiration – should be about 9-10 posterior ribs seen

1inspiaration1 1inspiration2

Labeled ribs:




Images from:

Nose Refresher




A resident of ill-repute was minding his own business on the way to his shift when he was assaulted. He complains of nose pain and that conference is too early in the morning. The attending was anxiously awaiting the arrival of said tardy resident, and then was immediately seen as above. What is is happening?

A. the correct approach to “feedback” for tardiness as per departmental policy

B. an attending of ill-repute minding her own business

C. bilateral carotid massage

D. an impending nasal fracture, which today’s pearl will be about

E. all of the above

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Having Trouble Finding That Gallbladder?

Try Bret’s expert tips to improve RUQ view and finding the GB using the sonographic rib spreader!



Carl “Scooter” Mickman