EMQs in Clinical Medicine.pdf - Peshawar Medical College

244 Miscellaneous
F
This is presentation of scarlet fever caused by the erythrogenic toxin of
group A streptococcal infection. This condition usually occurs in young
children because by the age of 12 years most individuals have developed
antibody against the exotoxin. The tonsils and pharynx are the usually
the primary focus of group A streptococcal infection. Release of erythrogenic
toxin causes the development of the generalized erythematous
macular rash. The punctate lesions are typically accentuated in the skin
folds, e.g. axillae, inguinal regions. Strawberry tongue and circumoral
pallor are common features of scarlet fever.
98 Medical emergencies
Answers: M F B H C
M
F
B
A 40 year old rescued from a factory fire presents with stridor and
cyanosis. Endotracheal intubation is unsuccessful.
Cricothyroidotomy is an emergency airway procedure that should be
performed only when other means of establishing an airway, including
endotracheal intubation, have failed. In this particular case the upper airway
obstruction is probably caused by extensive oropharyngeal oedema
from inhalation burns. The cricothyroid membrane can be located by
feeling for the thyroid cartilage anteriorly (most prominent cartilage of
the neck), and then running the index finger down until you can feel a
space between the thyroid (superior) and cricoid (inferior) cartilage.
A 21-year-old man presents with status epilepticus.
You must check to make sure that the patient is not hypoglycaemic. The
seizure may be stopped with intravenous diazepam, and prophylactic
phenytoin may be given to prevent further seizures.
In established status epilepticus, intravenous phenytoin is indicated to
prevent further seizures. If the seizures continue, general anaesthetic
induction agents, e.g. propofol, may be required.
A 35-year-old builder is brought to A&E after suffering a blow to the
side of the head at work. He did not lose consciousness but 4 hours
afterwards complained of a severe headache. He became very confused
and his conscious level is deteriorating. On examination he has
a dilated right pupil. Pulse 50 beats/min, BP 168/100 mmHg.
Given the history of head injury and signs of raised intracranial pressure,
it is likely that there is an extradural haemorrhage. This is usually caused
by a skull fracture tearing the middle meningeal artery. In this particular
scenario, the patient is displaying a Cushing response (dropping pulse
and rising blood pressure) with a lateralizing sign (dilated right pupil),
and there is a high risk of coning. Emergency management involves
drilling a Burr hole, evacuating the haematoma and clipping the middle
meningeal artery to stem the bleeding.