A 15-year-old white male is being evaluated after a fall down one flight of stairs. He was transported by the local rescue squad with his cervical spine immobilized. He walked briefly at the scene and did not lose consciousness. His only complaint is a mild, generalized headache. One episode of vomiting occurred shortly after the accident. No weakness or numbness has been noted. Vital signs, mental status, and neurologic findings are normal. Radiologic evaluation of the cervical spine is remarkable only for an air-fluid level in the sphenoid sinus.
Which one of the following abnormalities is most likely to be associated with this radiologic finding?
Correct Answer A:
A post-traumatic air-fluid level in the sphenoid sinus is associated with basilar skull fractures (choice A). This finding is frequently noted on cervical spine films.
→ Orbital floor fractures (choice B) may be associated with double vision, fluid in the maxillary sinus, an air-fluid level in the maxillary sinus, and diplopia.
→ Epidural hematomas (choice C) are more frequently associated with skull fractures in the area of the meningeal artery.
→ Zygomatic arch fractures (choice D) are more visible on Towne’s view. Characteristic swelling and lateral orbital bruising are typically present.
→ Mandible fractures (choice E) may be associated with dental misalignment or bleeding. Panoramic views are often diagnostic.
Imiquimod (Aldara) use in patients 12 years of age and over is approved for treatment of which one of the following conditions?
Since its FDA approval, imiquimod has been used off-label to treat all of the conditions listed, but is approved only for treatment of external genital and perianal warts in patients 12 years of age and over.
A 9-month-old male is seen for a routine well-baby examination. There have been no health problems and developmental milestones are normal. Review of the growth chart shows that length, weight, and head circumference have continued to remain at the 75th percentile. The examination is normal with the exception of the anterior fontanelle being closed.
Proper management at this time would include:
Correct Answer E:
The anterior fontanelle in the newborn is normally 0.6-3.6 cm, with the mean size being 2.1 cm. It may actually enlarge the first few months, but the medial age of closure is 13.8 months. The anterior fontanelle closes at 3 months in 1% of cases, and by 1 year, 38% are closed.
While early closure of the anterior fontanelle may be normal, the head circumference must be carefully monitored. The patient needs to be monitored for craniosynostosis (premature closure of one of more sutures) and for abnormal brain development. When craniosynostosis is suspected, a skull radiograph is useful for initial evaluation. If craniosynostosis is seen on the film, a CT scan should be obtained.
You see a healthy 7-year-old male who was bitten on the cheek 1 hour ago by a neighbor’s dog. On examination you find a jagged laceration about 2 cm long that extends into the fatty tissue.
Which one of the following would be appropriate in the management of this injury?
Dog bites are a common medical problem. Timely and copious irrigation with normal saline or Ringer’s lactate will reduce the rate of infection markedly. In dog/cat bites, only consider primary closure for bite wounds on the face; otherwise primary closure is contraindicated.
→ Cultures are usually not helpful unless the wound appears infected.
→ Amoxicilllin/clavulanate is the antibiotic of choice for a dog bite.
→ Since this is a neighbor’s dog, it can be observed at home for 10 days if the rabies vaccination is current, or at a veterinarian’s office if vaccination status is unknown.
Approximately 30%-50% of infants born to Chlamydia-positive mothers will have:
Chlamydial genital infection is reported in 5%-30% of pregnant women, with vertical transmission to > 50% of their infants at birth. An infant born to a mother with active chlamydial infection has a 50%-70% risk of acquiring infection at any anatomical site. Approximately 30%-50% of infants born to Chlamydia-positive mothers will develop conjunctivitis, and at least 50% of these children will also have nasopharyngeal infection. Infants born to women with chlamydial infection may also develop associated pneumonia, but this affects only 10%-20% of this population.
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