(BMJ) - A 14-yo girl presented w/ a swollen, ulcerated 5th toe. Sx began 8 days prior when she felt severe pain in her toe while wading in the English Channel, followed by swelling of her entire lower leg. What is the diagnosis?
Mycobacterium marinum infection
Stingray envenomation
Weever fish sting
Blue jellyfish sting
Sea urchin puncture wound
You are correct. This is a typical weever fish (Echiichthys vipera) sting presentation. This fish inhabits flat, sandy shores and has a heat-labile venom in its dorsal spines. Envenomation leads to pain, swelling, and occasionally systemic disturbances such as cardiac arrhythmias. Emergency tx involves immersing the wound immediately in nonscalding hot water for 30 to 90 min. Chronic pain and Raynaud phenomenon have been reported as complications of weever fish stings.
(BMJ) - A 34-yo woman presented w/ a tender, purple-brown nodule in her umbilicus. She had no unusual menstrual sx and had a recent uncomplicated pregnancy. Biopsy confirmed the diagnosis. What is it?
Sister Mary Joseph nodule
Pyogenic granuloma
Umbilical endometriosis
Umbilical hernia
Malignant melanoma
You are correct. Excision and biopsy revealed a focus of endometriosis. Characteristic symptoms of periodic pain and bleeding are not always present w/ umbilical endometriosis, and the appearance may mimic malignant melanoma. Fine needle aspiration cytology or excisional biopsy is required to distinguish it from cancerous lesions.
(BMJ) - A newborn presented w/ a fleshy lump in his nostril. CT scan confirmed the diagnosis, and it was successfully treated w/ a surgical procedure. What is it?
Nasal dermoid
Naso-ethmoidal meningocele
Choanal atresia
Foreign body
Dacryocystocele
You are correct. CT scan revealed a likely naso-ethmoidal meningocele appearing to extend from the ethmoid region on a small stalk of tissue, most likely neural in origin. Primary encephaloceles are congenital and have a prevalence of 0.8 to 5 per 10,000 live births. They are subdivided into (1) sincipital (fronto-ethmoidal), (2) basal (trans-sphenoidal, trans-ethmoidal, and spheno-orbital), and (3) occipital. The mechanism involves the defective closure of the anterior neural tube. Secondary encephaloceles are commonly due to trauma or postsurgical complications. This lesion was treated successfully via transnasal removal of the sac.
(BMJ) - A 76-yo woman had a 6-wk hx of presumed erysipelas, which did not respond to several courses of oral and IV abx. Exam: eczematous rash affecting the right cheek, right forehead, and right forearm; her left side was unaffected. Patient stated that she slept on her right side. What is the diagnosis?
Sweet syndrome
Lichen simplex chronicus
Herpes zoster
Harlequin syndrome
Allergic contact dermatitis
You are correct. The patient revealed that she always slept on her right side and had been placing drops of lavender oil on her pillow for several months to help her sleep. Patch testing confirmed allergic contact dermatitis to lavender oil. Her eczema quickly cleared w/ topical steroids and avoidance of lavender oil. Harlequin syndrome is asymmetric sweating and flushing due to a sympathetic nervous system lesion. Zoster causes a blistering rash. Lichen simplex chronicus is thickening of the skin due to repeated scratching or rubbing. Sweet syndrome may be unilateral but is associated w/ painful papules, nodules, vesicles, and systemic symptoms.
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(BMJ) - A full-term neonate was born w/ a mass on his leg and asymptomatic ASD and VSD. Exam: large, violaceous mass with grey/purple halo on left thigh. US: highly vascularized mass confined to the SC tissue. By 9 mo, the mass had completely regressed. What is the diagnosis?
Rapidly involuting congenital hemangioma (RICH)
Cobb syndrome
Infantile hemangioma
Dabska tumor
Pyogenic granuloma
You are correct. RICH is a distinct form of congenital hemangioma that originates in utero, proliferates during pregnancy, and then rapidly involutes postnatally during the first yr of life. In contrast, infantile hemangiomas present at 2 to 4 wks of age and regress over longer periods of time. Cobb syndrome is associated w/ spinal cord angiomas or AVMs. Pyogenic granulomas and Dabska tumors can be confused w/ hemangiomas but are distinguished by US findings.