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Haley Sinatro

EM@3AM: Endometritis

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A 37-year-old G2P2 female presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. She was discharged 3 days prior after a cesarean delivery to a single, full term, live born infant complicated by premature rupture of membranes. She notes associated chills and abdominal tenderness. On exam, she is ill appearing, tachycardic, and febrile. Her surgical incision is clean, dry, and intact. She has significant tenderness to the lower abdomen on palpation. On pelvic exam, she has moderate thick, foul-smelling purulent discharge. What is the diagnosis?

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EM@3AM: Oculomotor Nerve Palsy

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A 50-year-old female with no past medical history presents to the ED with a diffuse, constant headache onset a few weeks. The patient describes droopiness of the left eye and double vision associated with specific directional movements of the eye. On exam, you note ptosis of the left eye with findings as indicated in the photograph below (inability to adduct, ability to abduct). The left pupil is dilated at 5mm and minimally reactive to light; the right pupil is 3mm and reactive. The remaining cranial nerve testing and components of the neurological exam are normal.

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EM@3AM: Oropharyngeal Candidiasis

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A 32-year-old male with HIV presents to the ED for loss of taste. He noticed white plaques on his tongue. Although painless, the plaque is associated with a cotton sensation and a dull sense of taste. The patient reports being compliant with his medications and denies other symptoms. His tongue is covered in white curd-like plaques that are easily removed with scraping, leaving behind an erythematous base. The posterior oropharynx is without abnormality. What is the diagnosis?

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