(BMJ) - A 52-yo obese male (BMI >34) presented w/ painful, red, bulging left eye after rubbing his eye on waking. Exam: no afferent pupillary defect, VA 20/40 (pinhole 20/20) left, 20/20 right; normal fundoscopy. Exophthalmometry and CT confirmed the dx. What is it?
Thyrotoxicosis
Acute angle closure glaucoma
Floppy eyelid syndrome
Retrobulbar hematoma
Orbital cellulitis
You are correct. Floppy eyelid syndrome, often diagnosed in overweight middle-aged men, causes pseudoproptosis and is characterized by an easily everted, floppy upper eyelid, and upper palpebral conjunctivitis. Exophthalmometry showed no objective proptosis, and CT scan confirmed no proptosis or other ocular, orbital, or intracranial pathology. His eye showed punctate corneal erosions and hyperemic conjunctiva, no evidence of inflammation, and normal fundoscopy. His lids were repositioned and the patient was treated with topical antibiotics. In floppy eyelid syndrome, the upper eyelid everts during sleep, resulting in irritation and conjunctivitis.
(BMJ) - A man w/ major head trauma was admitted to the ICU and sedated. A urine osmolality was ordered. After centrifugation of the urine, it was noted to contain a pink pellet. What is the cause?
Ecstasy (MDMA) ingestion
Propofol sedation
ICU-related diabetes mellitus
Pink Kool-Aid ingestion
Rhabdomyolysis
You are correct. Propofol is known to cause changes in urine color. The drug also increases excretion of uric acid, leading to precipitation in urine and pink discoloration. The patient’s serum urate was 45 μmol/L (reference range 200-430). Alkalinization of the urine sample in the laboratory caused the pellet to dissolve and provided a useful confirmatory test.