396 Emergency Medicine
Superior vena cava syndrome (a)is caused by an obstruction of the
superior vena cava typically caused by the compression of a tumor. The
most common complaints include edema and venous distention of the face
and upper extremities. Facial plethora and telangiectasias are also commonly
noted. Aortic dissection (b)can cause a difference in BP in the extremities.
In general, patients complain of tearing chest pain that radiates into their
back. If suspicion is high for aortic dissection, a CT scan with contrast or
echocardiography should be performed to rule out the diagnosis. Angina
pectoris(d)refers to myocardial ischemia caused by insufficient coronary
blood flow to meet myocardial oxygen demand. It typically presents with
symptoms of chest discomfort relieved with rest or nitroglycerin. Patients
might complain of arm pain or radiation of pain to the arms, but the presen-
tation does not involve neurologic deficits. Vestibular neuronitis (e)refers
to acute self-limiting dysfunction of the peripheral vestibular system that
causes vertigo.
366.The answer is c.(Tintinalli et al, p 1418.)This patient presents with
symmetric proximal muscle weaknessand characteristic heliotrope rash
ofdermatomyositis.It is an idiopathic inflammatory myopathy with asso-
ciated dermatitis. The characteristic of the disease is progressive symmetric
proximal muscle weakness with possible dysphagia, symmetric heliotrope rash
in the periorbital region or neck, elevated creatinine kinase, and abnormal elec-
tromyogram and muscle biopsy. There is also an associated risk of malignancy.
Myasthenia gravis (a)is an autoimmune disorder of the neuromuscular
junction in which antiacetylcholine receptor antibodies compete with
acetylcholine at the nicotinic postsynaptic receptors. The disease causes
characteristic progressive reduction in muscle strength with repeated muscle
use. Bulbar muscles are most commonly involved, and patients report
worsening of symptoms at night and improvement with rest or in the
morning. MS (b)is an inflammatory demyelinating CNS disease resulting
in various neurologic abnormalities, such as optic neuritis, transverse myelitis,
and paresthesias. Rhabdomyolysis (d)refers to muscle fiber breakdown
because of a variety of etiologies, such as trauma, burns, ischemia, seizures,
excessive muscular activities, sepsis, and myopathies. Its complications
include hyperkalemia, metabolic acidosis, and acute renal failure. Disseminated
gonococcal infection (e)is a systemic disease secondary to the presence of
Neisseria gonorrhoeaein the bloodstream. In the early bacteremic phase
patients present with fevers, migratory polyarthritis, and rash; this evolves