Case no.2

A 56-year-old woman presented with complaints of an ulcerating lesion at the inner corner of right eye for the past 8 months. There had been an off and on history of yellowish discharge from the lesion; occasionally it is blood tinged. She had a history of trauma with a wooden stick at the affected site, 10 months earlier. Clinically, a firm mass could be palpated. Extraocular movements were full. Slit lamp and fundus examination were within normal limits in both eyes. CT scan showing coronal and axial view is shown above.

1. The most probable diagnosis is:                
                   a. sebaceous gland carcinoma
                   b. canaliculitis (Actinomyces)
                   c. chronic dacryocystitis with fistula
                   d. basal cell carcinoma

2. The treatment would be:
                  a. curettage of canaliculi and Amphoteracin B
                  b. dacryo-cystorhinostomy with stent
                  c. incisional biopsy
                  d. wide excision of the lesion with margin control

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Case no1

A 12 year old male with 4 days of sore throat comes into the office. He has been afebrile, has rhinorrhea, cough and one day of diarrhea associated with his sore throat. The throat is mildly erythematous with otherwise normal appearing tonsils. The best course of action is (this may be a controversial question
depending on your practice setting):

1.  Swab his throat and give a 10 day course of antibiotics, you will call him if the culture is negative for group A strep so that he can stop antibiotic treatment.
2.  Swab his throat, withhold antibiotics unless his culture is positive.
3. Advise him on symptomatic treatment.
4. Give him antibiotics without testing for group A strep.

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