(BMJ)—A middle-aged man with hx of mild HTN presented with thinning of half of his tongue and limited tongue movement that started 1 month prior. Exam: wasting of the left side of the tongue and deviation to left; neuro exam otherwise normal. Dx confirmed by imaging. What’s the dx?
Nasopharyngeal carcinoma
Tumor at base of skull
Carotid artery dissection
Glomus jugulare tumor
Ischemic stroke
You are correct. MR angiography showed an irregular double lumen of the internal carotid artery with a narrowed lumen, indicating dissection. Although it’s rare, internal artery dissection should be considered in an isolated hypoglossal, cranial nerve (CN) XII palsy. Other causes of isolated CN XII palsy include tumor or infiltrative disease, infections, compressive lesions, and infarcts anywhere along the course of the hypoglossal nerve. However, some cases are considered idiopathic, as in Bell palsy.

Emergency Medicine Journal 2021;38:302-307
(BMJ)—A woman in her 70s had tingling between her second and third fingers that evolved into a moist, raw lesion. She’d been washing her hands ~40x daily since the onset of the COVID-19 pandemic 3 months prior. Exam: shiny, red lesion in web space, with white collarette. What’s the dx?
Inverse psoriasis
Herpetic whitlow
Contact dermatitis
Candidal intertrigo
You are correct. This patient had interdigital candidiasis, a form of candidal intertrigo that occurs in the web spaces between the fingers, most commonly the third web (between the middle and ring fingers). Interdigital candidiasis is associated with frequent exposure to water. Consider interdigital candidiasis in patients with this characteristic appearance in the finger web spaces who report a history of frequent handwashing, immunosuppression, or both.

BMJ 2021;373:n729
(BMJ)—A 5-year-old girl in Taiwan presented with fever for 5 days and a 2-day hx of rash on her face, trunk, and limbs. She had returned from Indonesia, where her cousin had similar sx, 12 days prior. Exam: conjunctivitis, coryza, white lesions on the buccal mucosa, and maculopapular rash on face, chest, abdomen, and limbs. What’s the dx?
Measles (rubeola)
Kawasaki disease
Parvovirus B19
Dengue fever
You are correct. The white lesions in her mouth that resembled salt sprinkles were Koplik spots, which, along with rash, conjunctivitis, cough, and coryza, are the key sx of measles. In Taiwan, the second dose of measles vaccine is given sometime at age 5, and the child was due for her second dose sometime that year. Modified measles may occur in patients with partial immunity. Patients with modified measles might have a prolonged incubation period, less severe prodrome, and milder or subclinical sx, with discrete rashes of shorter duration. The patient was isolated immediately after dx and treated with supportive care. She recovered uneventfully.

BMJ 2021;372:n381