You are correct. Amputation was performed and histological examination identified pleomorphic rhabdomyosarcoma. Chest CT showed lung metastasis. The pt received systemic chemotherapy but died 6 mo later from progressive disease. Rhabdomyosarcoma accounts for <0.03% of all adult cancers; the extremities and trunk are the most common primary sites.

You are correct. The child has Frey, or auriculotemporal, syndrome, a rare complication of forceps injury frequently misdiagnosed as food allergy in childhood. After damage of the auriculotemporal nerve, aberrant regeneration of parasympathetic fibers in sympathetic pathways connected to blood vessels and sweat glands leads to flushing and eventually to sweating during salivation. Diagnosis is made clinically, based on an H&P characterized by unilaterality, chronology, absence of urticarial wheals, itching, swelling, and extra-facial extension, and reproduction of the observations by a simple objective test (in this case, chocolate challenge). This benign condition has a good chance of improvement or spontaneous resolution in children, and no specific tx is recommended.

You are correct. This pt was diagnosed w/ pyoderma gangrenosum (PG), a cutaneous ulcerative condition that is classified as a neutrophilic dermatosis. PG classically affects women aged 40 to 60 yrs and in half of all cases is associated w/ IBD, RA, myeloma, lymphoma, leukemia, or primary biliary cirrhosis. Diagnosis is mainly clinical; pts in whom PG is suspected should be urgently referred to a dermatologist for assessment and tx. A short course of oral steroids initially improved the pt’s skin, but she then had to be started on adalimumab after rapid deterioration of her Crohn dz and PG.

You are correct. This pt was diagnosed w/ acute primary angle-closure glaucoma (APACG), a rare but sight-threatening condition caused by an acute rise in intraocular pressure secondary to blockage of aqueous outflow. Risk factors include increasing age, Asian and Inuit ethnicity, female sex, and hypermetropia. Attacks can be precipitated by mydriasis, such as that caused by anticholinergic drugs and low-light situations. After emergency medical management w/ IV acetazolamide and eye drops, this pt had a right, then left, peripheral iridotomy before having argon laser iridoplasty in the right eye. Always consider APACG in a pt, irrespective of age and sex, who presents w/ headache or eye pain, and loss of vision in a red eye w/ a mid-dilated pupil.

You are correct. Findings were diagnostic for central retinal vein occlusion (CRVO). All investigations, including thrombophilia screen, were normal. The pt had been on desogestrel (a progesterone-only pill) for 3 mo. She was advised to stop the pill and was started on low-dose aspirin. CRVO completely resolved w/in a mo. The incidence of thrombosis differs across progesterone-only contraceptives, w/ desogestrel having the highest risk.

You are correct. Analysis of skin swabs from the groin, nose, and one of the lesions confirmed a suspicion of Panton-Valentine leucocidin (PVL)-positive S aureus. PVL-positive S aureus is a virulent, highly transmissible community-acquired strain that may cause recurrent skin infxns. This pt responded to a further course of flucloxacillin + skin decontamination w/ mupirocin; her skin cleared, and seizure control returned to normal.

You are correct. Gorlin sign is seen in half of patients w/ Ehlers-Danlos syndrome and systemic hypermobility. There is a link between Ehlers-Danlos syndrome and TMJ dysfunction, and clinicians should attempt to elicit this sign when assessing pts w/ temporomandibular joint or rheumatological problems. Only 8% to 10% of the “normal” population can perform this maneuver.

You are correct. History revealed participation in a game that tests the ability to withstand discomfort associated w/ close proximity to discharge of an aerosol canister. The recreational practice of ‘frosting’ (‘having a frosty’) involves the discharging of pressurized aerosol contents onto body surfaces. Resultant frostbite depends on duration of exposure and absolute temp reached. Unlike heat thermal burns, such cold injuries do not induce protein (dermal collagen) fragmentation; thereby, there is reduced likelihood of scar formation. Tx consists of simple nonabsorbent dressings, daily review, and avoidance of UV exposure to reduce subsequent hyperpigmentation. All cases merit consideration for psychosocial evaluation.

You are correct. A diagnosis of kerion was made and confirmed when scrapings from the child’s eyebrow grew Trichophyton verrucosum. He was treated w/ oral terbinafine and antibiotics. Kerion is an inflammatory reaction to ringworm, usually seen on the scalp of children and occasionally on the beard area of adults; secondary bacterial infxn is common. Prompt tx minimizes risk of scarring and permanent hair loss.