(BMJ) - A 30-yo cyclist skidded on a wet road and struck his head on a curb. He was alert and oriented with normal vital signs. Blood was noted originating from the left external auditory meatus, leaving a halo on the sheet. What is the diagnosis?
Ruptured tympanic membrane
Hemorrhagic mastoiditis
Maxillary sinus fluid leak
Basilar skull fracture
Ear foreign body
You are correct. The halo, or double-ring, sign occurs when CSF is mixed with blood in proportions of 30% to 90%. This sign, along with the blood and CSF separated into 2 layers in the cavum conchae, are classic findings of basilar skull fracture. CT confirmed the diagnosis. The patient was managed conservatively and discharged 3 days later when the CSF leak had stopped.
(BMJ) - A 2.7-kg boy was delivered as breech vaginal birth after uncomplicated pregnancy. The infant was well w/ normal exam except for multiple white nodules along alveolar ridge of maxilla that did not interfere with nursing. What are they?
Epstein pearls
Primordial cysts
Mucoceles
Bohn nodules
Natal teeth
You are correct. Bohn nodules are benign, self-limiting, smooth, white, keratin-filled cysts found most frequently on the maxillary arch. They are more common in term vs preterm infants. In contrast, Epstein pearls would be found on the palate; natal teeth on the mandibular ridge; and mucoceles on the labial mucosa. Primordial cysts would be seen in place of a tooth that is missing.
A 79-yo woman with PMHx of Wegener’s granulomatosis presented with hyperpigmentation of arms, face, and legs. Medication: methotrexate. Adrenal function and ACTH level normal. What is the diagnosis?
Methotrexate-associated hyperpigmentation
Addison disease
Cushing disease
Solar lentigo
Acanthosis nigricans
You are correct. Hyperpigmentation is a rare but reversible side effect of methotrexate. The patient’s methotrexate was stopped, and the hyperpigmented areas of skin began to return to normal.