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,...

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...

Anisocoria Clinical Summary

Anisocoria is a disparity of pupil size. Five to twenty percent of people have physiologic anisocoria, usually of less than 2 mm. This asymmetry is preserved in both light and dark conditions, and no other ocular abnormalities are present. If pathologic anisocoria is suspected, examine pupil size in both light and dark to determine which eye is affected anisocoria increases in the direction of action of the paretic iris muscle. A weakened iris sphincter muscle is accentuated by bright light....

Balanoposthitis Clinical Summary

Balanoposthitis is an infection and inflammation of the glans penis that also involves the overlying foreskin (prepuce). Balanitis is isolated to the glans, whereas posthitis involves only the prepuce. Pain, erythema, and edema of the affected parts of the penis are typically present. Patients may refrain from urination secondary to dysuria, or the edema may induce meatal occlusion, leading to urinary retention or obstruction. Common etiologies include overgrowth of normal bacterial flora...

Black Hairy Tongue Clinical Summary

Black hairy tongue (BHT) represents a benign reactive process characterized by hyperplasia and dark pigmentation of the tongue's filiform papillae. The elongated filiform papillae may reach up to 2 cm in length and vary in actual degree of pigmentation from light tan to black. Predisposing factors may include excessive smoking, gastroesophageal reflux, poor oral hygiene, chemotherapy, and the use of broad-spectrum oral antibiotics. Pigment from consumed food, beverages, and tobacco products...

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...

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...

Dacryocystitis Clinical Summary

Dacryocystitis is inflammation of the medial lacrimal apparatus, which usually follows occlusion of the nasolacrimal duct. Age distribution is bimodal, with peaks in infancy and after 40 years. Clinical findings include, pain, erythema, and swelling over the medical lacrimal apparatus, tearing, and possibly mucopurulent discharge from the punctum. Dacryocystitis may develop in 4 to 7 of newborn infants who do not yet have a patent nasolacrimal passage, and may progress to periorbital...

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...

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...

Hand Foot And Mouth Disease Clinical Summary

Hand, foot, and mouth disease is a seasonal (summer-fall) viral infection caused by coxsackievirus A16. Toddlers and school-age children are affected most commonly. It is characterized by a prodrome of fever, malaise, sore throat, and anorexia over 1 to 2 days, followed by the appearance of the characteristic enanthem in the posterior oropharynx and on the tonsillar pillars consisting of small, red macules evolving into small vesicles 1 to 3 mm in diameter that rapidly ulcerate. The oral...

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,...

Highaltitude Retinal Hemorrhage Clinical Summary

Retinal hemorrhages are common above 5200 m (17,060 ft) and are not always associated with acute mountain sickness (AMS). High-altitude retinal hemorrhages (HARH) are rarely symptomatic, but if found over the macula, these hemorrhages may cause temporary blindness. The diagnosis can be established by ophthalmoscopy. Without visualization of the lesion, the differential diagnosis of unilaterally decreased vision or blindness at high altitude includes migraine equivalent, cerebrovascular...

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...

Hypertrophic Pyloric Stenosis Clinical Summary

Hypertrophic pyloric stenosis (HPS) is characterized by progressive postprandial, nonbilious vomiting that steadily increases in frequency and amount due to hypertrophy of the pyloric musculature and edema of the pyloric canal, producing gastric outlet obstruction. It is usually diagnosed in infants from birth to 5 months, most commonly at 2 to 8 weeks of life. The vomiting may become forceful and is then described as projectile (although this pattern is not always present). There is a familial...

J V

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...

Nasal Cellulitis Clinical Summary

Nasal cellulitis is an infection of the skin and subcutaneous tissues and does not include nasal cartilage. It is most common at the extremes of age. Bacterial invasion due to disruption of the skin is the usual cause. Streptococcus pyogenes and Streptococcus aureus cause most infections. Risk factors include nasal surgery, instrumentation, diabetes, immunocompromise, and nasal piercing. Clinical features include pain, redness, swelling of the nasal tissues. Headache, fever, and malaise suggest...

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...

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...

Pelvic Fracture Clinical Summary

Pelvic fractures are often the result of motor vehicle crashes or falls and are fraught with associated complications. The pelvis should be regarded as a ring identification of one fracture or dislocation should prompt surveillance for another. The purpose of the pelvis is to bear weight and to protect the visceral organs consequently, a fracture of the pelvis will often compromise these functions. Pain is the most common complaint however, patients with pelvic fractures may present unconscious...

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...

Secondary Syphilis Clinical Summary

The rash of secondary syphilis occurs 2 to 10 weeks after resolution of the primary lesions. It begins as a nonpruritic macular rash that evolves into a papulosquamous rash involving primarily the trunk, palms, and soles. The rash is often annular in shape. Diffuse, painless lymphadenopathy is also seen at this stage. Mucous patches represent mucous membrane involvement of the tongue and buccal mucosa. Condyloma lata can be seen during this stage, as can patchy alopecia. The manifestations of...

Superior Vena Cava Syndrome Clinical Summary

This symptom complex develops from obstruction of venous drainage from the upper body, resulting in increased venous pressure, which leads to dilation of the collateral circulation. Superior vena cava (SVC) syndrome is most commonly caused by malignant mediastinal tumors. Dyspnea swelling of the face, upper extremities, and trunk chest pain, cough, or headache may be present. Physical findings include dilation of collateral veins of the trunk and upper extremities, facial edema and erythema...

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...

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...