A 35 year old woman is brought to the ED by ambulance for confusion and syncope. Medics report that she was seen earlier that day in the ED and diagnosed with a URI. The patient is quite bizarre and is triaged in as a psych patient. She is oriented to name only. When asked if she is in pain she answers “20 minutes”. When asked again she speaks gibberish and is repetitive, answering “faculate”. She answers “yes” to all yes or no type questions including those that are obviously incorrect. To open ended questions she answers with more gibberish often using the words “faculate” and “brakelight”. On exam, she is purposeful, her vital signs and are normal and her exam is non-focal, but limited in that she follows only simple commands. Lab tests are normal except for 25 WBC’s in her urine a WBC count of 14, a serum glucose of 215 and a tox screen which is positive for opiates. CT of the brain is normal. A diagnostic procedure is performed with results shown below. What is the diagnosis?

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An 11 year old boy is sent to the ER by his pediatrician to rule out meningitis. The child has had headache and fever on and off for about two weeks. Three days ago he saw his doctor and was diagnosed with the flu. However, since then the headache has worsened and the fever reached 102 Farenheit. In addition the child has developed weakness in his right leg. On exam there is questionable meningismus, but notable right leg weakness as well as 15 beats of clonus and a positive Babinski sign. The patient’s CT scan is shown below. The radiologist is uncertain of the significance of the fluid colection, but says since there is no mass effect, you may proceed with a spinaltap. What is the diagnosis? What is the best course of action? CLICK HERE FOR ANSWER

TELL A FRIEND: Cut & paste this link, ERPocketBooks.com into an e-mail and forward.

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National Nurses’ week starts this Monday. Don’t forget to show your appreciation. Food works great, but it’s not too late to order medical pocketbooks as gifts. Until May 12th, for every 4 books you order I’ll throw in a 5th book free! That’s 20% off.

ERPocketBooks.com is a website designed for health-care providers to enhance their education and patient care.   GotSafety.ORG is a website designed for the public to learn how to avoid the most common injuries and illnesses that land people in the nation’s ER’s.  Both websites include free content as well as information on a number of books which are available for purchase.

Our medical mysteries of the month contain valuable educational images.  Proper consent was obtained for all of the images from patients who were happy to be able to contribute to the medical education process.  Their contributions may one day help other people they will never know.

In this spirit, read on…

A 72 year old female is referred to cardiology for clearance to undergo eye surgery. During her review of symptoms she mentions that she occassionally gets 5-10 minutes of epigastric pain after meals which is always releived by Pepto-Bismol. Below is her EKG taken in the office while she is pain free. She is sent to the ER for further evaluation. A repeat EKG is unchanged and cardiac enzymes are negative. Can she be cleared for surgery or should you recommend a stress-test first?

For the answer CLICK HERE or link below.

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A 47 year old man presented to the ED with left eye irritation that had been present for about two weeks. He denies trauma, headache, discharge and vomiting but does have some degree of photophobia and slightly blurred vision that seems to clear when he blinks. On exam you note injection without discharge. Look closely at the image. What type of conjunctivitis does he have? For Answer, click here, or link below.

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