You are correct. This passenger sustained serious bilateral chemical injuries to the eyes due to airbag deployment. Airbags are inflated by nitrogen gas produced from sodium azide; deployment also produces sodium hydroxide, a highly alkaline and irritant chemical. This substance permeates through the airbag on deflation and can cause an alkaline burn to the eye. This pt sustained serious, potentially blinding corneal damage due to the late presentation. An eye exam should be considered in all pts exposed to airbag deployment.

You are correct. Pyogenic granuloma is a benign vascular entity often related to minor trauma. Lesions are usually painless but often bleed. Orf, a parapox virus infection associated w/ sheep, was excluded by lack of viral particles on bx. Treatment w/ topical super-potent corticosteroid ointment led to complete resolution over subsequent wks in this pt, obviating the need for surgery.

You are correct. Tattoo reactions are a rare but recognized manifestation of sarcoidosis. In sarcoidosis, a state of granulomatous hypersensitivity exists, w/ reactions to different antigens in a range of organs. NTM infections due to contaminated tattoo inks have been reported, but present w/ localized skin, not pulmonary disease. The other choices are unlikely to be associated w/ tattoo reactions. Skin bx in this pt showed granulomatous infiltrate consistent w/ sarcoidosis. He responded well to a course of steroids.

You are correct. A bluish line along the gingival margin (Burton line) is seen in chronic lead poisoning. An elevated serum lead level confirmed the diagnosis. Though lead paint is banned in many countries, safe paint removal practice remains unsatisfactory in many places, including Eastern Europe. Lead poisoning should thus be considered in migrant workers. Treatment is w/ chelation therapy.

You are correct. Eczema herpeticum typically presents with a "shotgun blast" appearance and is caused by herpes simplex virus. Patients with atopic eczema are susceptible to viral infections and should avoid contact with people who have active cold sores. Delay in treatment may cause scarring of skin and eyes and may be life-threatening in a child. This patient’s rash resolved rapidly with oral acyclovir.

You are correct. Lambing ear is a recently identified ear rash that occurs in farmers during lambing season. This occupational disease occurs through close contact with products of conception. Juvenile spring eruption is a sun-induced skin condition affecting the light-exposed skin of the ears, most commonly in boys and young men in early spring. Orf virus is rarely transmitted to humans from sheep and causes papulopustular, viral-filled lesions. Q fever is a systemic illness that may also be transmitted by sheep. Cutaneous lupus erythematosus has distinct histology from lambing ear.

You are correct. Pseudocysts of the pinna do not respond to antibiotics, aspiration, or I&D; fluid simply reaccumulates. They are treated with a helical rim incision and removal of the anterior cyst wall. The posterior cartilage is curetted to remove any granulation tissue, and dental rolls are stitched to either side of the pinna to compress the area. Prompt treatment prevents deformity of the pinna.

You are correct. The patient had secondary syphilis confirmed by serology. She was initially diagnosed with pemphigus, but biopsy showed abundant plasma cells prompting syphilis testing. Secondary syphilis is highly contagious.