Go For The Glory Quiz: Drug-induced Hypersensitivity; Rhinosinusitis and Depression; Blue Nevus; Leg Injury

QUESTION 1:

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A 78-year-old man with a history of hypertension, type 2 diabetes mellitus, and mantle cell lymphoma after splenectomy and chemotherapy came to the ED with a rash of 5 days’ duration and a 2-week history of dyspnea. He also had cough with white sputum and occasional fever without chills. The patient had taken vancomycin and piperacillin/tazobactam 3 weeks earlier during a hospitalization for osteomyelitis. The diagnosis was drug-induced hypersensitivity syndrome.

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QUESTION 3:

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A 50-year-old woman was concerned about the recent appearance of a small dark spot on the forehead. She denied trauma to the affected area and was not taking medication. The lesion proved to be a benign blue nevus.

QUESTION 4:

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A 39-year-old man presented with right heel and lower leg pain that began the night before during a basketball game. Another player had jumped and inadvertently landed on the back of the patient’s lower leg. No abrasions or ecchymoses are present in the area of the injury. The right lower extremity has diffuse edema, and a palpable groove proximal to the heel is evident. The area is tender. A Thompson test performed bilaterally finds some flexion of the right foot but less flexion than the left foot.

QUESTION 5:

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A woman in her 40s presented to the ED complaining of right shoulder and neck pain that started after her car was hit by a truck. Plain films of the shoulder and cervical spine were negative and she was sent home. She returned to the ED 8 days later and said that although her pain had improved, she now had severe vertigo and a mild headache. A neurologic evaluation and a CT scan of the head found no abnormality. Two days later, the patient returned yet again, with persistent vertigo, but no new symptoms. The ED physician at this visit ordered a carotid and vertebral arterial duplex ultrasound examination, the results of which were markedly abnormal. A magnetic resonance angiography study of the neck is shown here.

ANSWER KEY:

Question 1. Answer: f

Question 2. Answer: a

Question 3. Answer: c

Question 4. Answer: b

Question 5. Answer: d