Rumsfeldism

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Rumsfeldism

• Now, settle down, settle down. Hell, I'm an old
  man, it's late in the evening and I'm gathering
  my thoughts here."

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A Picture is worth 1000 words!

• RASHES IN THE ED..and physical findings and .

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Objectives

• Sit back and relax
• Yell out an answer
• Yell out a Guess
• Put your photographic memory on
• If all else fails .sit back and relax
• Or sleep perchance to dream

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Donald Rumsfeld Secretary of Defense USA Feb 12th
2002

• "As we know, there are known knowns. There are
  things we know we know. We also know there are
  known unknowns. That is to say, we know there are
  some things we do not know. But there are also
  unknown unknowns - the ones we don't know we
  don't know."

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Donald Rumsfeld

• "If I know the answer I'll tell you the answer,
  and if I don't, I'll just respond, cleverly."

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Rumsfeldism

• I'm not into this detail stuff. I'm more
  concepty .

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28yo Male, Diffuse Abdo PainName the sign seen
below, and give 3 possible causes
Q. 1
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60yo female, two weeks of severe pain on L side
of face. Ophthalmic findings are below. Describe
the findings. Diagnosis?
Q. 8
Right Eye
Left Eye
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A 20 year old man presented to the ED after an
alleged blunt assault.His right ear is as shown.
What is the treatment for this condition?
Q. 9
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A 60 year-man walked into the ED complaining of a
"swollen mouth under tongue" for 2 -3 days. He
denied any dyspnea, but did describe difficulty
swallowing saliva. Other than a remote history of
a tonsillectomy, his past history was entirely
negative.The patient was awake and alert and in
no respiratory distress. A photo of his physical
exam is below. Diagnosis? Treatment?
Q. 10
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• A 22 year old male complains of a very sore
  throat for the last three days

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Peritonsillar Abscess

• Tips for draining?

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Painful red face
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How to differentiate cellulitis from erysipelas?

• Cellulitis
• More indiscreet margins

• Erysipelas
• Sharply demarcated borders
• Fiery red, indurated
• Lymphatic involvement
• St. Anthonys Fire

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The 55 year-old man depicted in the photos below
presented to theED following a witnessed
generalized seizure. He had no prior history of
seizures. What is your diagnosis, what is your
concern, and what is the appropriate management
of this patient?
Q. 24
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This isnt makeup. Name the sign and what it may
indicate.
Q. 12
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A 83 year old woman presents with facial
swelling. The airway is stable. What is the
condition? What are some of the causes of this
condition?
Q. 13
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A 4yo girl C/o of rash and joint pain. Nine days
earlier was treated for sinusitis
trimethoprim/sulfamethoxazole. 2d before the ED
visit, the patient developed a rash and the
antibiotic was discontinued. In ED C/O swelling
in her hands, wrists and feet, and of cramping in
her abdomen.Exam did not appear toxic, T 37,
rash as below urticarial wheels and some target
lesions. Swelling of both ankles with a purple
discoloration was suggestive of purpura.
Urinalysis showed trace protein and no blood.
Exam otherwise normal. DIAGNOSIS and TREATMENT?
Q. 14
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25yo male, dx with mycoplasma pneumonia (via cxr
and serology) 2 weeks ago given perscription
for doxycycline which he NEVER filled. Now
painful rash seen below. (PMHx nil)Diagnosis
and Treatment?
Q. 20
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65yo male, 10d history of dyspnea and headache.
No meds, 60 pack-year history of smoking, PMHx
non-contributory. Describe findings and diagnosis.
Q. 22
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Painful nodules
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Causes of Erythema Nodosum?

• Infectious
• Strep
• Staph
• TB
• Fungal (coccidiomycosis)
• Drugs
• OCP
• Sulfonamides

• Pregnancy
• Hodgkins, NHL
• Sarcoid
• IBD
• Behcets

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• Nikolskys sign
• Causes?
• Erythema multiforme major (SJS)
• Staph scalded skin syndrome (SSSS)
• Toxic Epidermal Necrolysis (TEN)
• Toxic Shock Syndrome
• Bullous pemphigus
• Burns

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• A 28 year old male presents with a non-pruritic
  rash to his torso that over time spreads to his
  extremities

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• Questions?

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Kaposis Sarcoma

• Cause HHV-8
• Initial presentation cutaneous
• Tumour cells --gt spindle cells
• Can spread to mucous membranes, internal organs
• AIDS defining illness

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• A gentleman presents with the following
• Questions?
• Differential Diagnosis?

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Genital Ulcers

• Chancroid
• Herpes
• Syphilis
• Behcets
• Other
• Lymphogranuloma venereum (LGV)
• Granuloma inguinale (GI)
• Drug eruption
• Systemic/dermatologic

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Travel
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Beach walker
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Bio T
Tularemia
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Bio T
Tularemia
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Bio T
Oriental Rat Flea Usual Plague Vector
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Bio T
Chickenpox Early
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Try not. Do or do not, there is no try
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On Medicine.

• Once you start down the dark path, forever will
  it dominate your destiny, consume you it will.

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Rumsfeldism

• Learn to say 'I don't know.' If used when
  appropriate, it will be often."

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Diarrhea-others
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• Petechiae - Small, nonblanching, erythematous
  macules, less than 0.5 cm (pinpoint to pinhead
  size), due to rupture of small blood vessels
  leading to hemorrhage.

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purpura
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• Left upper extremity shows necrotizing fascitis
  in an individual who used illicit drugs. Cultures
  grew Streptococcus milleri and anaerobes
  (Prevotella species). Patient would grease, or
  lick, the needle before injection.

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• Left lower extremity in a 56-year-old patient
  with alcoholism who was found comatose after
  binge drinking. Surgical drainage was performed
  to treat the pyomyositis-related, large,
  nonfoul-smelling (sweetish) bullae. Gram
  staining showed the presence of gram-positive
  rods. Cultures revealed Clostridial perfringens.
  The diagnosis was clostridial myonecrosis.

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38yo female, 4days of finger below, very painful,
no known trauma. Likely etiology? Do you ID?
Treatment?
Q. 5
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DD

• Measles Scarlet fever Drug reactions
  Stevens-Johnson syndrome Other febrile viral
  exanthems Toxic shock syndrome Rocky Mountain
  spotted fever Staphylococcal scalded skin
  syndrome Juvenile rheumatoid arthritis
  Leptospirosis Mercury poisoning

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Kawasaki
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Spread at the speed of a 747
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Strength and Honour