445.A 60-year-old woman presents to the ED complaining of pain in her
right eye and burning sensation over half of her forehead and scalp. On
physical examination, you notice a patch of grouped vesicles on an erythe-
matous base located in a dermatomal distribution on her scalp and fore-
head. There are also a few vesicles located at the tip of the patient’s nose.
Her visual acuity is 20/20 bilaterally, heart is without murmurs, lungs are
clear, abdomen is soft, and there are no gross findings on neurologic exam-
ination. Which of the following is the most concerning complication of this
patient’s clinical presentation?
a. Central nervous system (CNS) involvement leading to meningitis
b. Ophthalmic involvement leading to anterior uveitis or corneal scarring
c. Cardiac involvement leading to endocarditis
d. Permanent scarring of her face
e. Nasopalatine involvement leading to epistaxis
446.A 31-year-old nurse in your hospital has noticed a lesion in her left
eye. She denies change in vision, pain, fevers, or discharge. A picture of her
eye is shown below. Which of the following is the most likely diagnosis?
490 Emergency Medicine
a. Hordeolum
b. Chalazion
c. Dacryocystitis
d. Pinguecula
e. Pterygium
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB.Atlas of Emergency
Medicine. New York, NY: McGraw-Hill, 2002: 43.)