180.A 50-year-old man presents to the ED complaining of fever, sore
throat, and neck pain for 24 hours. He states that 1 week ago he had two
molars extracted from his mouth. His BP is 145/75 mm Hg, HR is 102 beats
per minute, temperature is 101.2°F, and his RR is 16 breaths per minute. On
examination you notice that the patient is drooling. There is erythema and
swelling of his submandibular area that gives the appearance of a “bull
neck.” His tongue is swollen and elevated and the floor of his mouth is ten-
der. There is no fluctuant mass in his mouth. Which of the following is the
most likely diagnosis?
a. Acute mastoiditis
b. Peritonsillar abscess
c. Ludwig angina (LA)
d. Acute necrotizing ulcerative gingivitis (ANUG)
e. Streptococcuspharyngitis
181.A 44-year-old man presents to the ED complaining of right foot pain.
He states while playing basketball 2 weeks ago, he stepped on a nail that
punctured through his sneaker and cut his great toe. He went immediately
to the ED, where an x-ray was taken and confirmed negative, in addition to
being administered tetanus prophylaxis. On physical examination, his toe
is swollen, erythematous, and tender to palpation. There is no obvious
break in the skin or abscess present. His BP is 120/75 mm Hg, HR is 80 beats
per minute, temperature is 100.4°F, and RR is 16 breaths per minute. Which
of the following organisms is the most likely pathogen?
a. Neisseria gonorrhoeae
b. Staphylococcus epidermidis
c. Sporothrix schenckii
d. Pseudomonas aeruginosa
e. Salmonellasp.
184 Emergency Medicine