cases with questions and answers...test ur self

[Prof.Salahuddin]

السلام عليكم و رحمة الله و بركاته
this topic done by: Pediatricion

http://www.mssm.edu/emergmed/photoland/periorb1.jpg

7 year old boy was bit on his eye-lid by a mosquito and presents with a swollen, red, eye. How do you proceed with your evalution?

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Most importantly you must determine whether this is orbital or periorbital cellulitis by asking the boy to move his eye. If eye movement is painful it is likely that he has orbital cellulitis and therefore must be admitted, given I.V. antibiotics, and get an ophthomology evaluation. If eye movement is painless, however, as it was in this case, it is likely to be periorbital cellulitis and is treated with P.O. antibiotics and follow-up


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http://www.mssm.edu/emergmed/photoland/router1.jpg

75 year old man cut himself with a router partially exposing his extensor pollicis longus tendon. How must you evalute this injury? BONUS QUESTION: Which other tendons comprise the anatomical snuff-box?


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Before one closes this wound it is important to directly visualize the tendon and examine it for injury. If the tendon is more than 50% severed one should not attempt to repair it in the E.R. setting. Close the wound and immobilize the thumb, a surgeon can repair the tendon at a later date. BONUS ANSWER: The Anatomical Snuff-box is bordered by the Extensor Poll. Longus, Ext. Poll. Brevis and the Abductor Poll. Longus

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http://www.mssm.edu/emergmed/photoland/dogbite1.jpg

43 year old man who was bit on the hand by a pit-bull this morning. What are your primary concerns regarding this patient?

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Get an X-Ray, the pit-bull's powerful jaws frequently fracture bone. In addition, a broad-spectrum P.O. antibiotic such as Augmentin 250 TID should be given prophylactically. You must also, of course, question the rabies-infection status of the *** and treat your patient accordingly
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cont.

[Prof.Salahuddin]

http://www.mssm.edu/emergmed/photoland/baby.jpg

25 month old with a rash on the face. It is now spreading to the trunk. What is your diagnosis?

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This is Erythema Infectiosum or "fifth disease" caused by parvovirus B19. It may resolve and then reappear with environmental stimulation. Complications are rare
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http://www.mssm.edu/emergmed/photoland/leg1.jpg

19 y.o. soldier with a fever and headache. What is your diagnosis and plan?


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This a purpuric rash in a man with meningeal signs and fever. He should be on respiratory isolation until you have ascertained whether this is indeed meningococcemia
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http://www.mssm.edu/emergmed/photoland/leg2.jpg

30 y.o. woman complains of an itchy foot after spending 2 nights on the couch in the surgical waiting room. What is your diagnosis and treatment?


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These are scabies bites and trails. Lindane 1% cream is the treatment of choice
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http://www.mssm.edu/emergmed/photoland/shingle2.jpg

75 y.o. woman with a rash for two weeks that's not getting better. What can you tell her?


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This is herpes zoster in a T4 or T5 distribution. It is not unusual for this to last 3 to 6 weeks if not treated. Acyclovir or valcyclovir may shorten the course, but not all patients respond to therapy.
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http://www.mssm.edu/emergmed/photoland/redmouth.jpg

79 y.o. woman with two hours of swelling around her mouth and tongue, and mild dyspnea. What are your concerns?

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This woman has a histroy of allergic reactions, but has also been taking an ACE-I. The swelling was limited to her mouth and tongue. She was admitted to an ICU for close observation. The edema due to ACE-I's does not often affect the larynx and intubation is still possible even with severe swelling. Some physicians chose early intubation to avoid possible complications
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cont.

[Prof.Salahuddin]

http://www.mssm.edu/emergmed/photoland/mouthsor.jpg

A boy at his first birthday party fell with a party horn in his mouth. What would you do?


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This is a laceration of the soft palate. These can cause many problems secondary to infection and disfigurement if not well irrigated and managed. This child necessitated an Oral Surgery consult.
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http://www.mssm.edu/emergmed/photoland/penis1.jpg

56 y.o. male with 5 days of pus drainage from his penis. What happened


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This man had a penile implant placed two weeks earlier in Santo Domingo. He now has gangrene on his glans and requires surgical debridement and reconstruction
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http://www.mssm.edu/emergmed/photoland/t_nail1.jpg
http://www.mssm.edu/emergmed/photoland/t_nail2.jpg

50 y.o. diabetic with chronic pain and pus from his toenail. What is the diagnosis and treatment?

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This is a paronychia. Due to the chronic nature of the problem, the adjacent nail should be removed for proper drainage and healing, as shown in the second photo
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http://www.mssm.edu/emergmed/photoland/chest1.jpg

56 y.o. male with unrelated complaints. What do see on his chest, and what does it mean?


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These are spider angiomas. They are produced during the excessive estrogen state produced by chronic cirrhosis. This man is a chronic alcoholic
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http://www.mssm.edu/emergmed/photoland/pinkeye.jpg

38 y.o. welder complaining of pain in his left eye for several hours. What do you see in his eye, and what would you do about it?

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There is a small white foreign body visible on his cornea. This was better seen and removed by slit lamp. The rest of the eye and the inner sides of the lids must be examined. If any corneal ulcerations are found or a rust ring from a metal object, then o phtho follow up is recommended
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http://www.mssm.edu/emergmed/photoland/legrash.jpg

21 y.o. male complaining of 1.5 days of rash on his thigh and soreness of his leg muscles. He has had a "cold" for the last week without fever or headache. He admits to hiking in the woods about 2 weeks ago. What is your diagnosis and treatment?


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This is raised, flat patch with a surrounding blanched ring. This may be a simple allergic rash, but the possibility of acute Lyme infection must be considered and treated. Lyme titers were sent and he was started on doxycycline
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http://www.mssm.edu/emergmed/photoland/head2.jpg

34 y.o. male complaining of several hours of head swelling. He had been to the E.D. 2 days earlier for puritic papules on his scalp and was given Mycelex cream. He had also been self treating with triple antibiotic cream for 4 days. What is your diagno sis and treatment?


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He has a large, edematous, tender area on his scalp. This is probably an allergic reaction to the Mycelex cream. He responded well to steroid cream and discontinuation of the Mycelex.
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cont.

[Prof.Salahuddin]

http://www.mssm.edu/emergmed/photoland/chestab.jpg

58 y.o. woman with diabetes complains of 3 days of chest redness and painful swelling without fever. What is your diagnosis and treatment?


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This is a skin abscess on the chest and can be drained locally and packed. However, if she had had previous chest surgery, then further workup would be needed to rule out involvement of the sternum and mediastenum.
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http://www.mssm.edu/emergmed/photoland/ankle.jpg

72 y.o female complaining of ankle pain after stumbling down a curb. What is your diagnosis and treatment?


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This a dislocated ankle. Obviously the exam and x-rays would be very helpful. You must check here peripheral pulses and relocate the ankle immediately if the circulation is compromised. These patients often require surgery for ligament and tendon repai r.
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http://www.mssm.edu/emergmed/photoland/abscess.jpg

22 y.o. male complaining of 2 days of axillary pain. What is your diagnosis and treatment?


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This man has an abscess in his axilla. No lesions were found on the arm. This most likely developed from an infected sweat gland. Local I and D under sedation produces good results. If the abscess is deep, surgical consultation and O.R. drainage are re commended.
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http://www.mssm.edu/emergmed/photoland/elephant.jpg

A 40 y.o. man from Brazil with swollen legs for 2 months. What is your diagnosis and treatment?


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This is elephantiasis. It is a blockage of the lymphatic channels of the legs. In his case this is most probably caused by Wucheria bancrofti, and was the result of a mosquito bite. There is no good treatment for this infection, but Diethylcarba mazine 3mg/kg t.i.d. will reduce the number of microfilaria in the blood.
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http://www.mssm.edu/emergmed/photoland/maggot.jpg

A 45 y.o. homeless gentleman with foot pain for one week. What is your diagnosis and treatment?


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This man had an old ulcer betweeen his toes that is now infested with maggots. The maggots will selectively eat the dead tissue, making this a well debrided ulcer. The maggots were frozen with Ehtyl Chloride and removed. The lesion was then irrigated a nd dressed with silver sulfathiazine to improve granulation. No antibiotics were needed.
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http://www.mssm.edu/emergmed/photoland/elbowrsh.jpg

This a 19y.o. male complaining of this itchy rash on his elbow for the last 2 months. What is the diagnosis and treatment?

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This is psoriasis. Psoriasis can present with varied appearances, but this scaley rash on the extensor surfaces of the joints is classic. This patient was referred to Dermatology for therapy. Current therapies include UV light, tar, Calcipotriol, Anthr alin, occlusive dressings, and steroid creams.
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that's it


GOooOD LucK
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الموضوع الأصلي على الرابط
http://www.medkaau.com/vb/showthread.php?t=9449
تمنيتنا أن تتم الفائدة
مع تحيات سفراء بوابة مكة الطبية
Angel's Call
The brave heart
White soul
Prof.Salahuddin

[mshmolvi]

شكر الله لكم

[GooDmaN]

nice Q & A

[DR_R3D]

very nice

thanks Prof.Salahuddin


best wishes