A 23-Year-Old Man Comes to the Physician Complaining of Worsening

question 386

Multiple Choice

A 23-year-old man comes to the physician complaining of worsening headache over the past week.  He is "under a lot of stress at school" and having trouble sleeping because the headache is constant.  Two weeks ago, he had an insect bite on his right cheek and now both of his eyes are swollen.  He also has lost his appetite and vomited twice today.  His temperature is 38.3° C (101° F) , blood pressure is 130/90 mm Hg, pulse is 104/min, and respirations are 20/min.  Examination shows erythema and swelling of the right cheek and bilateral eyelid edema, right greater than left.  Bilateral extraocular movements are restricted.  The bilateral forehead and mid-face are extremely tender to light palpation.  Which of the following is the most likely diagnosis?

• A)Acute angle-closure glaucoma
• B)Brain abscess
• C)Cluster headache
• D)Cavernous sinus thrombosis
• E)Migraine with visual aura
• F)Periorbital cellulitis

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Definitions:

Blinking

The rapid closing and opening of the eyelid, which is a reflex action to protect the eye from irritants.

Motor Skills

Abilities required to control the muscles and movements of the body, divided into fine (small movements) and gross (larger movements) motor skills.

Finely Tune

To make very small adjustments to something in order to achieve the best or desired performance.

Motivates

Provides reason or incentive for someone to act or behave in a certain way.