Only those who dare to fail greatly can ever achieve greatly.–Robert F. Kennedy

Welcome back to RoshCast for Episode 46! Let’s kick off this episode with a rapid review of molluscum contagiosum.

* Molloscum contagiosum is caused by poxvirus. It is seen in children, sexually active adults, and immunocompromised patients like those with HIV.* The rash presents as painless, pearly, umbilicate papules, and it is spread by direct skin-to-skin contact.* Children present with lesions on the face, trunk, and extremities, whereas sexually active adults can present with lesions in the genital regions, lower abdomen, and thighs. The rash tends to spare the palms and soles.* Most patient will not require therapy with spontaneous resolution occurring in months. Those with extensive lesions may benefit from cryotherapy.* HIV positive patients with a CD4 count less than 100 are at greater risk for developing molluscum contagiosum.

Teaching Image

Now onto this week’s podcast

Question 1

Which of the following organisms is one of the most commonly implicated in the development of a lung abscess?

A. Klebsiella pneumoniae

B. Peptostreptococcus

C. Staphylococcus aureus

D. Streptococcus pneumoniae

Teaching Image

Question 2

A 26-year-old man presents to the ED after being hit in the head by a foul baseball. The patient was initially alert and talking to you. He is now becoming progressively more somnolent. Which of the following would you expect to see on a non-contrast computed tomography scan of the head?

A. A collection of blood layering in the basilar cisterns

B. A crescent-shaped frontal hematoma crossing suture lines

C. A lenticular-shaped hematoma in the temporal region

D. An intraparenchymal hemorrhage within the frontal lobe

Teaching Image

Question 3

A 55-year-old man who is taking several antihypertensive medications presents to the ED with nausea, vomiting, shortness of breath, and a rash after eating a home-cooked Thai meal at a friend’s house about one hour ago. The symptoms began within seconds of the first bite of his meal. Despite the patient being administered 2 doses of intramuscular epinephrine, diphenhydramine, dexamethasone, and crystalloid fluids, his blood pressure remains at 75/38 mm Hg. Which other medication should be considered in this patient?

A. Cimetidine

B. Glucagon

C. Norepinephrine

D. Octreotide

Question 4

A 36-year-old man presents to the ED after having a seizure. He has a folder full of medical records dating back 15 years. Several of the records are from other cities and states. It is now 11:00 pm on a Friday night. His primary care physician, neurologist, and psychiatrist are “out of town,” and he believes that he needs to be admitted for the duration of the weekend. He has another episode in the ED and immediately following this he returns to his baseline.