Tubal ectopic pregnancies are commonly diagnosed during the first trimester. Here we present a second-trimester tubal ectopic pregnancy that was previously misdiagnosed as an intrauterine pregnancy on a first-trimester ultrasound. A 39-year-old gravida 1 para 0 woman at 15 weeks gestation presented with 10 days of progressive, severe abdominal pain, along with vaginal bleeding and intermittent vomiting for two months. She was ultimately found to have a ruptured left tubal ectopic pregnancy. Second-trimester ectopic pregnancies carry a significant maternal mortality risk. Even with the use of ultrasound, they are difficult to diagnose and present unique diagnostic challenges.

We report a case of bradycardia-associated torsade de pointes in which the underlying long-QT syndrome appeared to be attributable to primary cardiac conducting system disease. Our patient presented complaining of presyncope and syncope. Serial electrocardiograms obtained over a period of 10 years demonstrated slowly progressive conduction system abnormalities, and evaluation revealed no other cause. The patient's dysrhythmia was refractory to magnesium but abated with cardiac pacing at a moderate rate. A review of the relevant literature on congenital and acquired long-QT syndrome is included.

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Introduction: Bilingual aphasia is an atypical stroke presentation in the multilingual patient where an isolated aphasia occurs in one language while the other remains unaffected. Case Report: A multilingual male presented to the emergency department with expressive aphasia to English but who was still able to speak fluently in French. Receptive English was preserved. While his National Institute of Health Stroke Scale score was technically zero, his pure aphasia component qualified him as an exception. He regained some repetitive English, so fibrinolyitic therapy was not initiated. Conclusion: Bilingual aphasia is an indication for fibrinolysis given the impact that a pure aphasic stroke has on quality of life.

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