Go For The Glory Quiz: Asymptomatic Facial Papules; Pediatric Gastrostomy Complications; Unexplained Trismus; Renal Abscess.

April 17, 2013

Facial papules; pediatric gastrostomy complications; unexplained trismus; renal abscess.

QUESTION 1:



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A 48-year-old man presents for treatment of herpes zoster. As an incidental finding, numerous flesh-colored, asymptomatic papules are noted on the central part of his face. The patient states that these have been present for several decades.

QUESTION 2:

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A gastrostomy tube-dependent 5-year-old girl (weight, 20 kg) presented with a 2-day history of fever and lethargy. Urine and blood were obtained for culture. Two days later, a urine culture turned positive for Escherichia coli. The patient was given ciprofloxacin suspension (200 mg via G-tube bid [10 mg/kg/dose]). After the patient received 2 doses, the parents noticed that the G-tube was clogged off.

QUESTION 3:



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A 47-year-old man in no apparent distress presented with intermittent facial pain, involuntary right facial muscle contractions, bilateral muscle spasms, trismus, involuntary tongue protrusions, tongue trauma, and an excessive gag reflex. Six months after treatment of caries and an inadequate root canal fill in tooth 30 and 29, respectively, he returned with left facial pain related to deep caries in tooth 12. An antibiotic was prescribed, but symptoms persisted and worsened. MRI and CT findings were normal. Electromyography of facial muscles showed abnormal activity in the right facial muscles.

QUESTION 4:



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A 29-year-old woman presented with a 2-day history of left-sided abdominal pain, urinary frequency, suprapubic pressure, dark urine, temperature of 37.8°C (100.1°F), and chills. A urine culture grew Klebsiella pneumonia. The diagnosis was renal abscess.

QUESTION 5:



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A 27-year-old woman asks about slightly itchy and scaly “white spots” on her face.

ANSWER KEY:



Question 1. Answer: c

Question 2. Answer: b

Question 3. Answer: a

Question 4. Answer: c

Question 5. Answer: b