A 17-year-old boy presents to his primary care physician for eye pain. The patient states that it has been going on for the past 3 days and has been steadily worsening. He recently suffered a superior orbital fracture secondary to playing football without a helmet that required no treatment other than to refrain from contact sports. The patient's past medical history is non-contributory, and his vitals are within normal limits. Physical exam demonstrates pain and swelling inferior to the patient's eye near the lacrimal duct. When pressure is applied to the area expressible pus is noted. Cranial nerves II-XII are grossly intact. Which of the following is the most likely diagnosis?
AOrbital cellulitis
BHordeolum
CPeriorbital cellulitis
DDacrocystitis
EAbscess
A 25-year-old woman presents to the physician with a complaint of several episodes of headaches in the past 4 weeks that are affecting her school performance. These episodes are getting progressively worse, and over-the-counter medications do not seem to help. She also mentions having to raise her head each time to look at the board while taking notes; she cannot simply glance up with just her eyes. She has no significant past medical or family history and was otherwise well prior to this visit. Physical examination shows an upward gaze palsy and convergence-retraction nystagmus. What structure is most likely to be affected in this patient?
AAqueduct of Sylvius
BInferior colliculi
C3rd ventricle
DTegmentum
ECorpora quadrigemina
A 47-year-old woman presents to the emergency department with a fever and a headache. Her symptoms started yesterday and have rapidly progressed. Initially, she was experiencing just a fever and a headache which she was treating with acetaminophen. It rapidly progressed to blurry vision, chills, nausea, and vomiting. The patient has a past medical history of diabetes and hypertension and she is currently taking insulin, metformin, lisinopril, and oral contraceptive pills. Her temperature is 104°F (40.0°C), blood pressure is 157/93 mmHg, pulse is 120/min, respirations are 15/min, and oxygen saturation is 98% on room air. Upon further inspection, the patient also demonstrates exophthalmos in the affected eye. The patient's extraocular movements are notably decreased in the affected eye with reduced vertical and horizontal gaze. The patient also demonstrates decreased sensation near the affected eye in the distribution of V1 and V2. While the patient is in the department waiting for a CT scan, she becomes lethargic and acutely altered. Which of the following is the most likely diagnosis?
AAcute closed angle glaucoma
BCavernous sinus thrombosis
CBrain abscess
DPeriorbital cellulitis
EIntracranial hemorrhage
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