Hy 2101 As Terminator says" I'll be back"

[tommyk]

Hy 2101

:cool: Case: A 60-year-old Hulk Hogan named complains of severe, sharp, shooting pain in his face. He describes the episodes as being "like a bolt of electricity" that are brought about by touching a specific area, last about 60 seconds, and occur many times during the day. Neurologic examination is completely normal, but it is noted that part of his face is unshaven because he fears to touch that area:) . Gadolinium-enhanced MRI shows no abnormalities of the trigeminal nerve. What is the disease and what is the med of choice? (Favorite Step 1er)

1-Migraine headaches, NSAIDS
2-Trigeminal neuralgia, Anticonvulsants
3-Obsessive Compulsive Disorder, Sertraline












a) The clinical description is that of trigeminal neuralgia ("tic douloureux"), which is treated with anticonvulsants. Carbamazepine is usually the first choice, but phenytoin has also been used. Antidepressants, such as amitriptyline, have also been tried. Surgical decompression of the nerve or stereotactic ablation are used in recalcitrant cases

[tommyk]

Case: 10 year old boy, he is brought to the pediatrician because of a 3-day history of skin lesions. Ouch!

On physical examination, he has multiple yellow, crusted erosions below the nares and on the cheeks, chin, and upper extremities. [LOOK FOR PICTUREon Google]. The rest of the examination is normal.

Lesion is more superficial, involving infection of the top layers of the skin with streptococcus (strep), staphylococcus (staph), or both. The skin normally has many types of bacteria on it, but intact skin is an effective barrier that keeps bacteria from entering and growing within the body. When there is a break in the skin, bacteria can enter the body and grow there, causing inflammation and infection. Breaks in the skin may occur with insect bites, animal bites, or human bites, or other injury or trauma to the skin. You see what begins as an itchy, red sore w/ blisters, oozing and finally becomes covered with a tightly adherent crust. It tends to grow and spread. The infection is carried in the fluid that oozes from the blisters.
What is the disease? What is the drug they will ask??

1-Amoxicillin
2-Penicillin
3-Ketoconazole
4-Amphotericin B
5-Cephalexin
6-Clindamycin
7-Topical Steroids
8-Vitamin A
9-Vitamin C



























a) #5, CEPHALEXIN!![Look for the NBME to show a picture of this specific lesion] Bullous impetigo (it is contagious) esp. (staphylococcal impetigo) is caused by an epidermolytic toxin produced at the site of infection, most commonly by staphylococci of phage group II. The toxin causes intraepidermal cleavage below or within the stratum granulosum. Bullous impetigo is most common in infants and children. It typically occurs on the face, but it may infect any body surface. There may be a few lesions localized in one area, or the lesions may be numerous and widely scattered. One or more vesicles enlarge rapidly to form bullae in which the contents turn from clear to cloudy. The center of the thin-roofed bulla collapses, and a thin, flat, honey-colored crust may appear in the center with a bright red, inflamed, moist base that oozes serum. In most cases, a tinea-like scaling border replaces the fluid-filled rim as the round lesions enlarge and become contiguous with the others .The border dries and forms a crust. The lesions have little or no surrounding erythema. Regional lymphadenitis is uncommon with pure staphylococcal impetigo. There is some evidence that the responsible staphylococci colonize the nose and then spread to normal skin prior to infection. Serious secondary infections (e.g., osteomyelitis, septic arthritis, and pneumonia) may follow seemingly innocuous superficial infections in infants. The drug of choice for impetigo is oral cephalexin.

Tommyk, do not just read, but try to understand.

[md90]

I will never forget this.. why? As part of the last semester at my school, we get to do an introductory to clinical sciences; we had a little girl come in with this, and thought that it was chicken pox; we had not done the physical exam.. just doing the interview; I could see that it was crusted.. but once I started the physical exam.. I saw that the infection was around the mouth, below the cheek, and it went to her outer ear; it was tender for me to touch the ear; I checked her on the torso and extremities, and could see nothing except for one or two... I knew that it was NOT chicken pox... but I drew a BLANK and could not think of impetigo... I was sooooo mad at myself!!! I felt that I had let my micro professor down... So now, I have not forgotten it,.... it's in my brain!!!