Environmental Exposures 471
439.A 20-year-old college student presents to the ED with a cutaneous
lesion as depicted below. He is brought in by friends who report being out in
an open field during stormy weather when the injury occurred. The patient
denies any recent travel or sick contacts. He also denies any symptomsexcept
for some generalized confusion. Which aspect of the physical examination
of this patient is initially most pertinent to the nature of this type of injury?
a. Testing of cranial nerves
b. Otoscopic evaluation of tympanic membranes
c. Evaluation of gait cadence
d. Testing of cerebellar deficits
e. Palpating the cervical spine for tenderness
(Reproduced, with permission, from Tintinalli J, Kelen G, and Stapczynski J.Emergency
Medicine A Comprehensive Study Guide. New York, NY: McGraw-Hill, 2004: 1238.)