(BMJ) - An 80-yo man on warfarin for atrial fibrillation tripped on a curb, striking his head w/o LOC. Exam: abrasion on R temple, R eye chemosis, and decreased vision but no afferent pupillary defect. CT scan confirmed the diagnosis. What is it?
Traumatic glaucoma
Subconjunctival emphysema
Retrobulbar hematoma
Graves ophthalmopathy
Ruptured orbit
You are correct. The patient had subconjunctival emphysema due to orbital wall fracture through the lamina papyracea diagnosed by CT. The scan showed no evidence of retrobulbar or intracranial hemorrhage, though this diagnosis was of primary concern in a patient on warfarin with head and facial trauma. An afferent pupillary defect is often seen with retrobulbar hematoma but wouldn't be expected with subconjunctival emphysema. This condition is self-limited. He was treated conservatively with lubricant drops.
(BMJ) - A woman presented with a chin lesion for >1 year that intermittently drained pus. Exam: purulent lesion, poor dentition. What is the diagnosis?
Tertiary syphilis gumma
Granuloma annulare
Thyroglossal cyst
Folliculitis
Dental sinus
You are correct. The patient was referred to a dentist who confirmed dental sinus and initiated treatment. The lesion did not look typical of any common skin cancer. Dental sinus should be suspected in lesions around the mandible.
(BMJ) - A 72-yo woman presented with an erythematous rash on her abdomen with induration and nodules. A biopsy confirmed the diagnosis. What is it?
Lymphangitis carcinomatosa
Contact dermatitis
Erysipelas
Caput medusae
Herpes zoster
You are correct. The patient was diagnosed clinically with lymphangitis carcinomatosa, inflammation of lymphatics as a result of malignancy. Skin biopsy confirmed metastatic adenocarcinoma from an undiagnosed left breast cancer.
(BMJ) - A 36-yo man with HIV, Pneumocystis jirovecii pneumonia, and a CD4 count of 23 presented with an itchy rash on his hands, ears, and scalp. Other family members also had itchy rashes for months. What is the diagnosis?
Lichen planus
Crusted scabies
Darier disease
Contact dermatitis
Bed bug bites
You are correct. Crusted, or Norwegian, scabies usually occurs in immunocompromised hosts and is highly infectious. In contrast to ordinary scabies in an immunocompetent patient in whom 10 to 15 mites might be found, thousands of mites may be detected in the crusted variant. The patient was treated with permethrin and ivermectin.
(BMJ) – A 25-yo man w/ short bowel syndrome received several IV abx and antifungals for Hickman line sepsis. Within 48 h, he developed a well-demarcated, exfoliative rash on his buttocks. No other inciting factors were present. What is it?
Erythroderma
Baboon syndrome
Contact dermatitis
Tinea corporis
Thermal burn
You are correct. The distinctive appearance of this rash is consistent with systemic drug-related intertriginous and flexural exanthema, also known as baboon syndrome. Several drugs, mainly antibiotics, are reported triggers. The condition is usually self-limited upon withdrawal of the offending agent.