Catscratch Disease Clinical Summary

Catscratch disease is a benign, self-limited condition caused primarily by Bartonella henselae that manifests with regional lymphadenopathy (Fig. 14.54), which usually follows (1-3 weeks) red-brown, nontender papules at the presumed site of bacterial inoculation. A history of contact with or scratch from a cat is usually present. Lymphadenopathy may persist for months and in rare cases patients may develop complications such as encephalitis, osteolytic lesions, hepatosplenic lesions, weight...

Otitis Externa Clinical Summary

Otitis externa (OE), or swimmer's ear, is an inflammation and infection (bacterial or fungal) of the auricle and external auditory canal (EAC). Typical symptoms include otalgia, pruritus, otorrhea, and hearing loss. Physical examination reveals EAC hyperemia and edema, otorrhea, malodorous discharge, occlusion from debris and swelling, pain with manipulation of the tragus, and periauricular lymphadenopathy. Several factors predispose the EAC to infection increased humidity and heat, water...

Internalexternal Hemorrhoids Clinical Summary

External hemorrhoids result from the dilatation of the venules of the inferior hemorrhoidal plexus below the dentate line. They have a covering of skin, or anoderm, versus internal hemorrhoids, which have a mucosal covering. Hemorrhoids commonly present with an episode of rectal bleeding of bright red blood after defecation. This results from the passage of the fecal mass over the thin-walled venules, causing abrasions and bleeding. Symptoms from external hemorrhoids include swelling, burning,...

Prolapsed Rectum Clinical Summary

Rectal prolapse occurs when anorectal tissue slides through the anal orifice. Prolapse may be partial, involving only the mucosa (prolapse is < 2 cm), or complete, involving in full thickness extrusion of the rectal wall. Prolapse may result from laxity of the pelvic floor, weak anal sphincters, and or lack of mesorectal fixation. Patients complain of bleeding, mucous discharge, rectal pressure, or a mass. Problems with fecal incontinence, constipation, and rectal ulceration are common as...

Emergency Department Treatment and Disposition

Nonsteroidal anti-inflammatory medications are used with excellent results in the acute setting, along with joint immobilization and rest. Colchicine is a reasonable alternative, but it often has side effects such as nausea, vomiting, and diarrhea. It is also associated with serious toxicity, including bone marrow suppression, neuropathy, myopathy, and death (particularly when given intravenously). Intramuscular injection of adrenocorticotropic hormone (ACTH, 40 to 80 units intramuscular or...

Clinical Summary

Gout is an inflammatory disease characterized by deposition of sodium urate monohydrate crystals in cartilage, subchondral bone, and periarticular structures. An acute attack is characterized by sudden onset of monarticular arthritis, most commonly in the metatarsophalangeal (MTP) joint of the great toe, with swelling, erythema, and tenderness. Gout can also occur in other joints. The deposits of crystals in the tissues about the joint produce a chronic inflammatory response termed a tophus. In...

Acute Posterior Myocardial Infarction Ecg Findings

With acute injury pattern ST segment depression in lead Vi and or V2 with acute injury pattern. With infarction pattern Small S wave and large R wave greater than 4 ms duration in lead Vi or V2 with infarction. With infarction pattern R-wave S-wave ratio greater than 1 in lead Vi or V2 with infarction. Figure 23.4A. SnurcE Knoop KJ, Stack LB. Stomrw AS, Thurman RJ The Arias of Emergency Medicine, 3rd Edition http wvwJacce5smedicine. cim Copyright The McGraw-Hill Companies, Inc. All lights...

Blistering Distal Dactylitis Clinical Summary

Blistering distal dactylitis is a cellulitis of the fingertip caused by Group A 3-hemolytic streptococci or Staphylococcus aureus infection in children from infancy to teenage years. The typical lesion is a fluid-filled, painful, tense blister with surrounding erythema located over the volar fat pad on the distal portion of a finger or toe. Polymorphonuclear leukocytes and gram-positive cocci can be found in the Gram stain of the purulent exudate from the lesion. The differential diagnosis...

Bluntforcepattern Injuries Clinical Summary

The most common blunt force is the contusion (Fig. 19.22). The pattern contusion is a common injury that helps identify the causative weapon. A blow from a linear object leaves a contusion that is characterized by a set of parallel lines separated by an area of central clearing. The blood underlying the striking object is forcibly displaced to the sides, which accounts for the pattern's appearance. Pattern injuries that an emergency physician should recognize include those caused by the hand...

Boutonnire And Swanneck Deformities Clinical Summary

Fine control of the fingers is achieved by a delicate balance between the extensor, flexor, and intrinsic tendons in each finger. The boutonnire deformity is a result of injury to the central slip insertion of the extensor hood on the dorsal surface of the middle phalanx. After a tear of the central slip, the flexor tendon is unopposed at the proximal interphalangeal (PIP) and the lateral bands of the extensor tendon contract. With time, these displace palmerly resulting in additional flexion...

Buccal Space Abscess Clinical Summary

The buccal space lies between the buccinator muscle and the overlying superficial fascia and skin. The maxillary second and third molars are the usual nidus of disease. Infection from the involved teeth erodes either superiorly through the maxillary alveolar bone, or rarely, inferiorly from the third mandibular molar through the mandibular alveolar bone into the buccal space. These patients present with unilateral facial swelling, redness, and tenderness of the cheek. Trismus is generally not...

Clenched Fist Injury Fight Bite Clinical Summary

The clenched fist injury classically occurs during a fight when the metacarpophalangeal (MCP) joint contacts human teeth, resulting in a laceration. Many patients will not divulge the true circumstances surrounding the injury therefore all wounds at the MCP joint must be considered a clenched fist injury until proven otherwise. These wounds occur most often in the dominant hand. Serious complications can result, including infection, loss of function, and amputation. Most wounds are...

Cold Panniculitis Popsicle Panniculitis Clinical Summary

Cold panniculitis represents acute cold injury to the subcutaneous fat. It manifests as erythematous, indurated plaques on exposed skin, especially the perioral areas and cheeks. Lesions appear 24 to 72 hours after exposure to cold and gradually soften and return to normal over 1 to 2 weeks usually without permanent sequelae. This phenomenon is caused by subcutaneous fat solidification and necrosis when exposed to low temperature. It is much more common in infants. It is believed to occur...

Corneal Ulcer Clinical Summary

A number of infections and inflammatory conditions can ulcerate the cornea. Common bacterial causes include Staphylococcus, Streptococcus, and Pseudomonas . Herpes simplex virus can also ulcerate the cornea, as can Acanthamoeba, a ubiquitous protozoan. Because contacts lens and contaminated solutions can permit microbial invasion, lens wear should raise clinical suspicion for a serious bacterial or protozoan infection. Fungal infections are rare but possible when either vegetable matter (such...

Delivery of the Placenta

Following delivery, gentle traction can be placed on the cord while the opposite hand is used to massage the uterine fundus. The placenta is generally delivered within 20 minutes and should be grossly inspected for evidence of a missing segment or coty ledon. The obstetrician should be notified as retained placental fragments often warrant manual exploration of the uterus, especially in the context of persistent postpartum bleeding. Unusual placental vasculature, such as a velamentous placenta,...

Drug Eruptions Clinical Summary

Exanthematous drug eruptions are an adverse hypersensitivity reaction. This symmetric, pruritic, morbilliform, blanching, erythematous eruption is the most frequent of cutaneous drug eruptions. The initially pruritic macules or papules usually become confluent and may progress to an exfoliative dermatitis. Acute generalized exanthematous pustulosis (AGEP), a type of drug eruption, presents 1 to 5 days after starting a new medication. Typically, a E> -lactam or a macrolide antibiotic is...

Elastic Wound Closure Strips

Elastic wound closures strips have the same advantages and indications as adhesives. Wound closure strips can be used alone or in conjunction with a tissue adhesive such as benzoin resin. This can be applied to the normal skin on either side of the wound and used as an anchor point for the strip. The edges of strip will curl up over time and can be trimmed by the patient as needed. Closure strips usually fall off completely in 2 to 3 weeks. Wound closure strips are not recommended in children...

Emergency Department Treatmentand Disposition

Imagenes Amigadalitis

Treatment is largely symptomatic except for antibiotics and rehydration. Analgesics, antipyretics, and throat sprays or gargles can provide symptomatic relief. Patients with known or suspected GABHS require antibiotics primarily to prevent rheumatic fever and suppurative complications. The Centor criteria are clinical decision rules developed to help guide physicians in testing and prescribing of antibiotics. Criteria include (1) tonsillar exudates, (2) tender anterior cervical adenopathy, (3)...

Figure 1129

Storrow AB, Thurman RJ The Atlas of Emergency Medicine, 3rd Edition httpi wivw,accessmedicine.tcm Source Knoop KJr Stack LB. Storrow AB, Thurman RJ The Atlas of Emergency Medicine, 3rd Edition httpi wivw,accessmedicine.tcm Copyright The McGramHHiK Companies, Inc. All rights reserved. Copyright The McGramHHiK Companies, Inc. All rights reserved. Source Knoop KJ, Stack LB. Storrow AB. Thurman RJ The Adas of Emergency Medicine, 3rd Edition 5ittpi www,accessmed cine,com...

Graze Wounds

Graze wounds are considered atypical and result from tangential contact with a passing bullet. The direction of the bullet's path may be determined by careful wound examination. The bullet produces a trough and may cause the formation of skin tags on the lateral wound margins (Figs. 19.16 and 19.17). The base of these tags point toward the weapon and away from the direction of bullet travel. Figure 19.16. Source Knoop KJr Stack LB. Stcrrow AS, Thurman RJ The At as of Emergency Medicine, 3rd...

H V W

Storrow AB, Thurman RJ The Adas of Emergency Medicine, 3rd Edition 5ittpi www,-a ccessmedicine.com Copyright The McGraw-Hill Gompanies, Inc. All rights reserved, Calcium Oxalate Crystals. Calcium oxalate crystals may be seen in the urine of the patient who ingested ethylene glycol and metabolized the parent compound to create oxalic acid. (Photo contributor Susan K. Strasinger. Urinalysis and Body Fluids , 3rd ed. Philadelphia Davis 1994.) 1. Provided adequate...

Herpetic Gingivostomatitis Clinical Summary

Herpetic gingivostomatitis is a viral infection commonly seen in infants and children caused by herpes simplex virus (HSV). Patients usually present with fever, malaise, decreased oral intake, cervical adenopathy, and pain in the mouth and throat. Vesicular and ulcerative lesions appear throughout the oral cavity. The gingiva becomes very friable and inflamed, especially around the alveolar rim. Increased salivation with foul breath may be present. Although fever resolves in 3 to 5 days,...

Hymenoptera Envenomation Clinical Summary

The order Hymenoptera includes wasps, hornets, yellow jackets, bees, and ants. Envenomation usually results in local pain, mild erythema, swelling, and pruritus. Severe systemic or toxic reactions may occur from one or multiple stings, manifesting as gastrointestinal symptoms, headache, pyrexia, muscle spasms, or seizures. Anaphylaxis may occur within minutes from a single sting, and may cause death from airway obstruction and or cardiovascular collapse. A serum sickness-type reaction may occur...

Inflicted Burns Clinical Summary

Burns in children are frequently the result of child abuse. The most common types of pediatric burns from abuse are immersion burns and contact burns. Certain clues may assist the physician in differentiating accidental burns from inflicted burns, but often considerable doubt remains even after a careful evaluation. In an immersion burn, a child is held firmly and deliberately immersed and will have burn margins that are sharp and distinct. If the child has little opportunity to struggle, few...

J V

Skin Scraping Scabies

Stomow AB, Thurman RJi The Atlas of Emergency Medicine, 3rd Edition )ittpi www .a ccessmedicine.com Copyright The McGraw-Hil Companies, Inc. All rights -reserved. Calcium Oxalate Crystals. Calcium oxalate crystals come in two shapes. The classically described octahedral, or envelope-shaped, crystals are made of calcium oxalate dihydrate. Calcium oxalate monohydrate crystals are needle-shaped. They are seen in acid or neutral urine. They may be found in the urine of...

Jaundice Clinical Summary

Jaundice presents as light yellowing of the skin, mucous membranes, and sclera it is generally detectable when bilirubin levels are about 3.0 mg dL. Many patients may not be aware of the faint yellowing of their skin and present with seemingly unrelated symptoms. Be aware that up to 50 of patients with jaundice will have pruritus. The most important diagnoses to rule out are hemolytic anemias, viral hepatitis, chronic alcohol abuse, autoimmune hepatitis, medications, primary biliary cirrhosis,...

Jugulovenous Distension Clinical Summary

Central venous (right atrial) pressure is reflected by distention of the internal or external jugular veins. Normal pressure is less than 3 cm of distention above the sternal angle of Louis. Distention greater than 4 cm should be considered abnormal. Evaluation begins by raising the head of the supine patient 30 to 60. The highest point of venous pulsation at the end of normal expiration is measured from the sternal angle of Louis. The presence of jugulovenous distention (JVD) should prompt an...

Melanoma Clinical Summary

Melanoma is a potentially fatal cutaneous tumor derived from epidermal melanocytes. Any age can be affected but the peak incidence is 20- to 45-year old patients (much younger than basal cell or squamous cell carcinomas). The most significant risk factor is a primary relative with melanoma. Evaluation of any pigmented lesion should include the ABCDE rule (A for asymmetry, B for irregular borders, C for color variegation, D for diameter greater than 6 mm, and E for elevation or thickening). Any...

Neonatal Mastitis Clinical Summary

Neonatal mastitis is an infection of the breast tissue that occurs in full-term neonates with a peak incidence in the third week of life. Females are affected more often than males in a 2 1 distribution. Clinically it manifests as swelling, induration, erythema, warmth, and tenderness of the affected breast. In some cases purulent discharge may be expressed from the nipple. Fever may be present in 25 to 40 of affected patients. Bacteremia is rare. Staphylococcus aureus is the most common...

Nursing Bottle Caries Clinical Summary

The etiology of dental caries is multifactorial with an interplay between microflora (plaque colonized with Streptococcus mutans), substrate (fermentable carbohydrates from breast milk, formula, or juice), and host (saliva and teeth). Nursing or milk bottle caries results from prolonged and frequent night time breastfeeding or sleeping with a bottle containing milk or sugar-containing juices. The sugars are fermented by the bacteria in plaque, lowering the pH in the mouth and resulting in...

Open Cricothyrotomy Technique

Identify the thyroid cartilage and the cricothyroid membrane directly caudally. 2. Cleanse skin surface with appropriate antibacterial medication. 3. Anesthetize skin surface with 1 lidocaine. 4. While stabilizing the trachea with the gloved nondominant hand, make a vertical incision through the skin overlying the cricothyroid membrane. 5. Dissect the tissues over the cricothyroid membrane in a horizontal direction, until the cricothyroid membrane is exposed. 6. Incise the cricothyroid membrane...

Orbital And Periorbital Preseptal Cellulitis Clinical Summary

Orbital (postseptal) cellulitis is a serious bacterial infection characterized by fever, painful purple-red eyelid swelling, restriction of eye movement, proptosis, and variable decreased visual acuity. It may begin with eye pain and low-grade temperature. In general, it is caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. It usually arises as a complication of ethmoid or maxillary sinusitis. If not treated promptly, it can lead to...

Pearl

The patient's vision may improve somewhat after a period of sitting or standing as the blood layers out. Patients often complain of monocular, decreased visual function and may describe a shadow or curtain descending over the eye. Other complaints include cloudy or smoky vision, floaters, or momentary flashes of light. Monocular visual filed defects may be noted, and central visual acuity is diminished with macular involvement. Fundal examination may reveal a billowing or tentlike elevation of...

Pearls

Maintain a high index of suspicion for this disease, especially in travelers, military personnel, or immigrants. 2. Leishmanial organisms are abundant in skin lesions, and can be demonstrated by stained smears of ulcer scrapings. Advice for treatment is also available through the CDC's Division of Parasitic Diseases. HERPES ZOSTER IN HIV PATIENTS Clinical Summary Following primary infection with varicella zoster virus, the virus migrates to the dorsal root sensory ganglia where it becomes...

Postpartum Perineal Lacerations Clinical Summary

Lacerations to the perineum occur commonly following a rapid, uncontrolled expulsion of the fetal head. Postpartum perineal lacerations range from minor to severe. Perineal lacerations due to birth trauma are categorized into four groups. First-degree lacerations are limited to the mucosa, skin, and superficial subcutaneous and submucosal tissues. Second-degree lacerations penetrate deeper into the superficial fascia and transverse perineal musculature. In addition to these structures, a...

Temporal Mandibular Joint Dislocation Clinical Summary

Temporal mandibular joint (TMJ) dislocation generally occurs in predisposed individuals after a vigorous yawn or seizure, or less commonly from direct trauma to the chin while the mouth is open. Acute dislocation occurs when the mandibular condyles displace forward and become locked anterior to the articular eminence. Masseter muscle spasm contributes to prevention of spontaneous relocation. Weakness of the temporomandibular ligament, an overstretched joint capsule, and a shallow articular...

Thirddegree Complete Av Block Ecg Findings

Atrial and ventricular electrical activities are entirely disassociated. The P-P and R-R intervals remain constant. P waves may be hidden in the QRS complex or may distort the shape of the T wave. The atrial rate is usually faster than the ventricular rate. Figure 23.17A. SnurcE Knoop KJ, Stack LB, Stomrw AB, Thurman (U TTieAfias of Emergency Medicine, 3rd Edition ttpi www.a ccessmedicme.com Copyright The McGraw-+lilC Companies, Inc. All rights reserved. SnurcE Knoop KJ, Stack LB, Stomrw AB,...

Trachoma Clinical Summary

Trachoma is the leading cause of infectious blindness in the world. It is endemic in areas of Africa, Asia, Latin America, the Middle East, and aboriginal communities in Australia. Trachoma is a chronic follicular conjunctivitis caused by Chlamydia trachomatis and is prevalent in populations with limited access to adequate sanitation and clean water. It is spread from person to person through ocular and respiratory secretions with flies constituting a major means of transmission. Although...

Type 1 Seconddegree Av Block Mobitz I Wenckebach Ecg Findings

Progressive PR-interval prolongation throughout the cardiac cycle until a P wave occurs without a QRS complex (dropped beat). After the dropped QRS complex, the cycle continues again with the PR interval of the first beat in the cycle always shorter than the PR interval of the last beat in the previous cycle. P wave may be hidden by the preceding T wave. Figure 23.15A. of Emergency Medicine, 3rd Edition http ynvw.acce55medicine.com Copyright The McGraw-Hill Companies, Inc. All rights reserved....

Umbilical Hernia Clinical Summary

The umbilicus is a common site of abdominal hernias. Predisposing conditions in adults most commonly include ascites and prior abdominal surgery. The size of the defect determines the symptomatology and incidence of incarceration, with smaller defects resulting in more pronounced symptoms and an increased incidence of incarceration. Pain is located in the area of the fascial defect. Contents of the hernia may be palpable and tender. Symptoms of obstruction (nausea, vomiting, and abdominal...

Cellulitis Clinical Summary

Cellulitis, an infection of the skin or subcutaneous tissues, is common. The characteristic findings are erythema with poorly defined borders, edema, warmth, pain, and limitation of movement. Fever and constitutional symptoms may be present and are commonly associated with bacteremia. Predisposing factors include trauma, lymphatic or venous stasis, immunodeficiency (including diabetes mellitus), and foreign bodies. Common etiologic organisms include group A 13-hemolytic Streptococcus and...

Chlamydial Infection Clinical Summary

After an incubation period of 1 to 3 weeks, males with chlamydial urethritis may present with a thin, often clear urethral discharge and or dysuria. Up to 10 of these men may be asymptomatic. Women may also develop urethritis, which may only cause dysuria with pyuria but not bacteruria and can be misdiagnosed as a urinary tract infection. Chlamydial cervicitis in women is almost always asymptomatic. Women may develop pelvic inflammatory disease with upper genital tract infection. Men may...

Varicella Chickenpox Clinical Summary

Chickenpox results from primary infection with varicella zoster virus and is characterized by a generalized pruritic vesicular rash, fever, and mild systemic symptoms. The skin lesions have an abrupt onset, develop in crops, start on the trunk and spread outward, and evolve from erythematous, pruritic macules to papules and vesicles (rarely bullae) that finally crust over within 48 hours. The classic lesions are teardrop vesicles surrounded by an erythematous ring (dewdrop on a rose petal). The...

Alopecia Clinical Summary

It can be classified into scarring (absence of follicles) and nonscarring (presence of follicles) alopecia. Scarring alopecia is commonly caused by discoid lupus erythematosus (erythematous mottled pigmentation and atrophic scalp scarring) and folliculitis decalvans (multiple crops of pustules on the scalp). Occasionally, prolonged bacterial and inflammatory fungal infections (kerion) can induce scarring on the scalp. Nonscarring alopecia results from...

Genital Herpes Clinical Summary

Herpes genitalis presents in several ways symptomatic primary infection, first-episode nonprimary infection, and recurrent infection. Symptomatic primary infection occurs when the patient develops symptoms upon first acquiring the virus. These symptoms can range from asymptomatic infection to a more prolonged and sometimes serious course. Patients initially infected asymptomatically may present at a later time with their first symptomatic episode of nonprimary genital herpes. Patients with...

Traditional Medicine In The Tropics

Traditional and complementary medical practices are common in all areas of the world. While frequently used in developed countries, these practices are even more prevalent in the tropics and among indigenous populations. The World Health Organization has estimated that as many as 80 of people in some countries rely upon traditional medical practices. Traditional medicine is common due to varied religious, spiritual, and cultural traditions and strongly held beliefs. Poverty, lack of education,...

Ultraviolet Radiation Exposure Clinical Summary

Ultraviolet (UV) radiation causes both acute and chronic skin changes. Sunburn is a partial-thickness burn, which may become a full-thickness injury if infected. Sun poisoning is a severe systemic reaction to UV radiation. Patients may complain of nausea, vomiting, headache, fever, chills, and prostration. Excessive UV radiation may cause injury to the cornea and conjunctiva, termed ultraviolet keratitis (photokeratitis, snow blindness). This painful condition may occur in skiers, welders, or...

Acid Tooth Erosion Bulimia Clinical Summary

Bulimia nervosa is an eating disorder with significant associated physical complications. It is characterized by binge eating with self-induced vomiting, laxative use, dieting, and exercise to prevent weight gain. Patients with bulimia are at risk for damage to the dental enamel and dentin as a result of repeated episodes of vomiting with chronic exposure to regurgitated acidic gastric contents. The lingual dental surfaces are most commonly affected. In severe cases, all surfaces of the teeth...

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Impetigo Penis And Testicles

Note Large images and tables on this page may necessitate printing in landscape mode. The Atlas of Emergency Medicine > Part 2. Specialty Areas > Chapter 14. Pediatric Conditions > Newborn Conditions > ERYTHEMA TOXICUM NEONATORUM CLINICAL SUMMARY Erythema toxicum neonatorum is a benign, self-limited eruption of unknown etiology that occurs in up to 70 of term newborns characterized by discrete, small, erythematous macules or patches up to 2 to 3 cm in diameter with 1- to 3-mm firm pale...

Pharyngitis Clinical Summary

Pharyngitis is an inflammation and commonly an infection of the pharynx and its lymphoid tissues. Viral causes account for 90 of all cases. Group A -hemolytic streptococci (GABHS) is responsible for up to 50 of bacterial infections. Other bacterial causes include other streptococci, Mycoplasma pneumoniae, Neisseria gonorrhea, and Corynebacterium diphtheriae. In immunocompromised patients and patients on antibiotics, Candida species can cause thrush. Sore throats that last longer than 2 weeks...

Scarlet Fever Clinical Summary

Scarlet fever manifests as erythematous macules and papules that result from an erythrogenic toxin produced by group A 13-hemolytic Streptococcus. The most common site for invasion by this organism is the pharynx and occasionally skin or perianal areas. The disease usually occurs in children (2-10 years of age) and less commonly in adults. The typical presentation of scarlet fever includes fever, headache, sore throat, nausea, vomiting, and malaise followed by the scarlatiniform rash. The rash...

Peritonsillar Abscess Clinical Summary

Peritonsillar abscess, or quinsy, is the most common deep neck infection. Although most occur in young adults, immune compromised and diabetic patients are at increased risk. Most abscesses develop as a complication of tonsillitis or pharyngitis, but they can also result from odontogenic spread, recent dental procedures, and local mucosal trauma. They recur in 10 to 15 of patients. The pathogens involved are similar to those causing tonsillitis, especially streptococcal species, but many...

Episcleritis Clinical Summary

Episcleritis is a common, benign inflammatory condition of the episclera. It most often affects young adults. Most cases are idiopathic, though up to a third may be associated with systemic conditions, and some cases may also be caused by exogenous irritants or inflammatory stimuli. Associated systemic disorders include gout, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, and herpes zoster. The symptoms, which include foreign body sensation, mild pain,...

Trench Mouth Acute Necrotizing Ulcerative Gingivitis Clinical Summary

Painful severely edematous interdental papillae are characteristic of trench mouth, or acute necrotizing ulcerative gingivitis (ANUG). Other associated features include the presence of ulcers with an overlying grayish pseudomembrane and a punched out appearance. The inflamed gingival tissue is friable, necrotic, and represents an acute destructive disease process of the periodontium. Fever, malaise, and regional lymphadenopathy are commonly associated signs. Patients may also complain of foul...

Aphthous Ulcers Canker Sores Clinical Summary

Aphthous ulcers are shallow painful mucosal ulcers of 1 to 15 mm. A prodromal burning sensation may be noted 2 to 48 hours before an ulcer is noted. The initial lesion is a small white papule that ulcerates and enlarges over 48 to 72 hours. Lesions are typically round or ovoid with a raised yellow border and surrounding erythema. Multiple aphthous ulcers may occur on the lips, tongue, buccal mucosa, floor of the mouth, or soft palate. Spontaneous healing occurs in 7 to 10 days without scarring....

Mastoiditis Clinical Summary

Mastoiditis is an infection or inflammation of the mastoid air cells that usually results from extension of purulent otitis media with progressive destruction and coalescence of air cells. Medial wall erosion can cause cavernous sinus thrombosis, facial nerve palsy, meningitis, brain abscess, and sepsis. With the use of antibiotics for acute otitis media, the incidence of mastoiditis has fallen sharply. Patients present with fever, chills, postauricular ear pain, and frequently discharge from...

Torus Palatinus Clinical Summary

Tori are benign nodular overgrowths of cortical bone. Although their physical appearance can be somewhat alarming to those unfamiliar with this entity, there is generally no need for concern. These bony protuberances occur in the midline of the palate where the maxilla fuses. Tori may also be located on the mandible, typically on the lingual aspect of the molar teeth. Tori are covered by a thin epithelium, which is easily traumatized and ulcerated. These ulcerations tend to heal very slowly...

Oral Herpes Simplex Virus Cold Sores Clinical Summary

Oral herpes simplex may present acutely as a primary gingivostomatitis or as a recurrence. Painful vesicular eruptions on the oral mucosa, tongue, palate, vermilion borders, and gingiva are highly characteristic. A 2- to 3-day prodromal period of malaise, fever, and cervical adenopathy is common. The vesicular lesions rupture to form a tender ulcer with yellow crusting and an erythematous margin. Pain may be severe enough to cause drooling and odynophagia, which can discourage eating and...

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Note Large images and tables on this page may necessitate printing in landscape mode. The Atlas of Emergency Medicine> Part 2. Specialty Areas> Chapter 17. Toxicological Conditions> METHAMPHETAMINE TOXICITY Clinical Summary A white powder easily dissolved in water, methamphetamine may be abused by ingestion, insufflation (snorting), parenteral injection, and smoking. Ice refers to a pure preparation of methamphetamine hydrochloride in large crystalline form. Clinical effects of...