Environmental Exposures 469436.A 31-year-old man presents to the ED with left calf pain. He reports
general malaise, nausea, and myalgias since a recent trip to Arkansas. His
initial vitals include oral temperature of 99°F, HR of 76 beats per minute,
BP of 128/70 mm Hg, RR of 16 breaths per minute, and oxygen saturation
of 98% on room air. Upon physical examination, there are diffuse petechiae
of the left lower extremity from the anterior distal tibia to the mid-thigh.
Closer examination reveals a small necrotic lesion at the level of the lateral
mid-calf with surrounding edema as seen below. The patient’s calf is tender
to the touch and upon dorsiflexion. Which of the following is the most likely
cause of this patient’s clinical symptoms?
a. Deep venous thrombosis (DVT)
b. Scorpion sting
c. Brown recluse spider bite
d. Black widow spider bite
e. Thrombocytopenia
437.A 23-year-old avid high altitude skier presents to the ED with intense
pain, tearing and bilateral ocular foreign body sensation. He denies any
trauma, past medical problems or contact lens use. His physical examination
is significant for bilateral decreased visual acuity, injected conjunctiva, and
diffuse punctuate corneal lesions with a discrete inferior border. His pupils
are equal, round, and reactive to light. Given this patient’s history and physical
examination, which of the following is the most likely diagnosis?
a. Corneal abrasion
b. Iritis
c. Ultraviolet keratitis
d. Corneal foreign body
e. Corneal laceration
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB.Atlas of Emergency
Medicine. New York, NY: McGraw-Hill, 2002: 531.)