Tooth Subluxation

A 27 year old male was seen in the emergency department following a trauma and bleeding from the mouth. On examination he was found to have teeth subluxation due to the trauma.

Tooth Subluxation. Note the presence of blood along the crevice of the gingival margin of both central incisors—an indication of subluxation following trauma. Mild displacement of the subluxated teeth is noted


Case Discussion: 
Tooth subluxation, the loosening of a tooth in its alveolar socket, is most commonly secondary to trauma; however, infection and periodontal disease may also produce subluxation.
Gingival lacerations and alveolar fractures are associated with dental subluxations. Gentle pressure to the teeth with a tongue blade or fingertip may produce movement, mild displacement, or blood along the crevice of the gingiva, all signs of subluxation.

Radiological Findings In Multiple Myeloma

An 87 years old male came to radiology department for X-ray chest with history of bone pains, lethargy and cough.

The above X ray shows generalized reduction in bone density with wide spread destructive foci. The lesions are more prominent and larger in size in the left clavicle and proximal part of humerus. In
view of destructive bone lesions, patient was subjected to X-ray skull.

Chest X-ray shows prominent and large size destructive foci in the left clavicle and proximal part of humerus (arrows). X-ray skull (inset) shows multiple wide spread osteolytic rounded circular

defects of varying diameter from 2 mm to 15 mm with no surrounding bone reaction or sclerosis. The disseminated or generalized form of plasma cell infiltration of bone marrow is known as multiple myelomatosis. It is much more common for the widespread form to present radiologically as a fully developed entity over 40 years of age. 

Men are affected twice as common as women. Persistent bone pain or a pathological fracture is usually the first complaint.

Clinical Discussion: The two cardinal features in multiple myeloma are generalized reduction in bone

Normal Fundoscopic Examination

Normal Fundus. The disk has sharp margins and is normal in color, with a small central cup. Arterioles and venules have normal color, sheen, and course. Background is in normal color. The macula is enclosed by arching temporal vessels. The fovea is located by a central pit.

Introduction. Fundoscopic examination should be a part of routine physical examination and it is important to know the normal findings in order to detect the abnormalities. Here a brief discussion is given about normal finding on fundoscopic examination.

Disk: The disk is pale pink, approximately 1.5 mm in diameter, with sharp, flat margins. The physiologic cup is located within the disk and usually measures less than six-tenths the disk diameter. The cups should be approximately equal in both eyes.

Vessels:The central retinal artery and central retinal vein travel within the optic nerve, branching near the surface into the inferior and superior branches of arterioles and venules, respectively. Normally the walls of the vessels are not visible; the column of blood within the walls is visualized. The venules are seen as branching, dark red lines. The arterioles are seen as bright red branching lines, approximately two-thirds or three-fourths the diameter of the venules.

Management Of Pressure Ulcers

A 85-year-old debilitated nursing home resident was found to have pressure ulcers. He has no evidence of bacteremia or osteomyelitis. Which of the following is an acceptable treatment?
A) Application of povidone-iodine gauze two times per day
B) Application of hydrogen peroxide 3 times per day
C) Systemic antibiotics for 7 to 10 days
D) Keeping the area clean and dry until granulation tissue forms
E) Surgical debridement

The answer is

Neonatal Conjunctivitis - A Brief Discussion

Neonatal conjunctivitis is acquired either during birth with passage through the mother’s cervix and vagina, or from cross-infection in the neonatal period.

Etiologies: More common etiologies include Chlamydia trachomatis, viruses (herpes simplex), and bacteria (Staphylococcus aureus, Streptococcal pneumoniae, Haemophilus species).

Clinical Features: 

• Presenting symptoms for Neisseria gonorrhoeae infection include a hyperacute bilateral conjunctivitis with copious purulent discharge, lid swelling, chemosis, and preauricular adenopathy.

            Thick purulent drainage in a newborn diagnosed with neonatal gonococcal conjunctivitis.

• For chlamydial conjunctivitis, the clinical features range from mild swelling with a watery discharge to marked lid swelling with a red and thickened conjunctiva with a blood-stained discharge. 
• Fluorescein staining of herpes simplex conjunctivitis demonstrates epithelial dendrites.
• Blindness can result from gonococcal eye infection in the neonate because the organism can invade the cornea. It is one of the few emergency conjunctival infections.
•  Nasolacrimal duct obstruction is common (up to 20%) in newborns and may present with findings suggestive of conjunctivitis. It is a diagnosis of exclusion in the neonate.

A Lipoma On The Chest Wall

A 54 years old male presents with a history of a large painless chest wall swelling on right side, which is there for the last seven years and has gradually increased in size. It was soft in consistency and non-adherent to the underlying ribs.

                                                 the swelling as seen from the back. 

An X ray chest was done which is shown below:

Chest X-ray shows a homogeneous soft tissue mass lesion without any calcification arising from the right lateral chest wall. The underlying ribs are normal; they show no erosion or pressure effect.

Diagnosis: History, clinical finding and X-ray chest are suggestive of lipoma.

Discussion: Ideally, CT is important as it provides a definitive diagnosis of lipoma but the patient