498 Emergency Medicine
(a)Complications of zoster include CNS involvement that can lead to
meningoencephalitis, myelitis, and peripheral neuropathy; however, the
patient’s current neurologic examination is unremarkable. (c)Although zoster
can disseminate to the visceral organs, like the brain, no cases of endocarditis
have ever been reported. (d)The rash of zoster usually heals within a month
and do not leave a permanent scar. (e)Epistaxis is not a complication of
zoster.
446.The answer is e.(Knoop, pp 43-44.)This patient has a pterygium,a
triangular growth of tissue from the bulbar conjunctiva to the periphery of
the cornea. It is more common on the nasal side of the cornea and may affect
one or both eyes. Pterygium is associated with exposure to wind, dust, and
sunlight. Most cases are asymptomatic and can be followed by an ophthal-
mologist. In cases where the pterygium grows into the visual axis or restricts
extraocular motion, surgical excision is indicated.
Pinguecula(d)is a yellow-whitish, fatty lesion of the bulbar conjunc-
tiva that may be on either side of the cornea, but is more commonly seen
on the nasal side. Dacryocystitis (c)is an inflammation of the lacrimal sac
that is characterized by pain, swelling, and erythema of the lacrimal sac on
the extreme nasal aspect of the lower lid. Pressure on the lacrimal sac in a
patient with dacryocystitis may express pus. Hordeolum (a)or stye is an
acute infection and abscess of the glands within the eyelids. Chalazions (b)
are granulomatous inflammations of meibomian glands in the eyelids. In
contrast to the erythematous, edematous, and painful hordeolums, cha-
lazions are usually hard and nontender swellings.
447.The answer is b.(Riordan-Eva et al, pp 62-79.)Ophthalmic medica-
tionsare color-coded. While this question may seem esoteric, it can be clini-
cally useful to know the colors of eye medications. In this case, knowing
that yellow caps are β-blockerssuggests that this patient may be currently
treated for glaucoma. Medication color knowledge can also help you rapidly
locate a specific medication from a large group of eye medications.
Antibiotics(a)are usually tan, mydriatics, and cycloplegics (c)are red,
miotics(d)are green, and anesthetics (e)are white. Mydriatics and cyclo-
plegics are medications that cause ciliary muscle paralysis and pupil dila-
tion. Miotics are medications that cause pupillary constriction.
448.The answer is c.(Tintinalli, pp 1452-1453.)This patient has classic
viral conjunctivitisthat is associated with a viral upper respiratory infection.