A patient presents with a pruritic, erythematous rash with edematous plaques and vesicles on the hands and fingers. The patient reports a history of exposure to detergents and frequent hand washing. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: B

Rationale: The presentation of a pruritic, erythematous rash with edematous plaques and vesicles on the hands and fingers in a patient with a history of exposure to detergents and frequent hand washing is most indicative of contact dermatitis. Contact dermatitis can be caused by direct contact with irritants such as detergents or chemicals, leading to skin irritation and inflammation. In this case, the history of exposure to detergents and hand washing suggests that the rash is likely due to irritant contact dermatitis. Atopic dermatitis, psoriasis, and pityriasis rosea do not typically present with the same pattern of rash in response to irritant exposure.

Correct Answer: A

Rationale: The presentation of a palpable, non-tender mass in the right neck, just below the angle of the mandible, along with ultrasound imaging findings of a well-defined, hypoechoic lesion with cystic components, is classic for a branchial cleft cyst. Branchial cleft cysts are congenital anomalies that arise from remnants of the branchial clefts or pouches during embryonic development. They are typically located along the anterior border of the sternocleidomastoid muscle, just below the mandible. Ultrasound imaging often shows a cystic lesion with well-defined borders and hypoechoic content, which is consistent with the described findings. Thyroglossal duct cysts usually present as midline neck masses that move with swallowing or tongue protrusion, not in the location described in the scenario. Lymphadenopathy would present as enlarged lymph nodes that may be tender and associated with systemic symptoms.

Correct Answer: B

Rationale: Ramsay Hunt syndrome is caused by the varicella-zoster virus affecting the geniculate ganglion, leading to a triad of symptoms known as the Hunt syndrome: facial paralysis, ear pain, and a vesicular rash in the ear or palate. The facial paralysis in Ramsay Hunt syndrome is usually peripheral, similar to Bell's palsy, but may be more severe. In addition to facial paralysis, the patient may have the inability to close the eye on the affected side (lagophthalmos) and loss of taste sensation on the anterior two-thirds of the tongue due to involvement of the chorda tympani nerve. This differentiation is important to consider in the context of our patient's presentation.

Correct Answer: A

Rationale: The presentation described is consistent with acute angle-closure glaucoma. This condition typically presents with sudden-onset severe eye pain, headache, nausea, and vomiting. On examination, the affected eye appears red, with a steamy cornea due to corneal edema and a mid-dilated, non-reactive pupil due to pupillary block from the forward displacement of the iris. Acute angle-closure glaucoma is considered a medical emergency as it can lead to permanent vision loss if not promptly treated. Prompt management involves reducing intraocular pressure to prevent further damage to the optic nerve.

Correct Answer: C

Rationale: The described presentation of a yellowish-white spot on the cornea with branching, filamentous opacities is characteristic of fungal keratitis. Fungal keratitis is typically associated with agricultural injuries, trauma involving plant material, or contact lens wear in agricultural environments. Fungal keratitis can be serious and may require intensive antifungal treatment to prevent vision loss. Prompt diagnosis and initiation of appropriate antifungal therapy are essential in managing fungal keratitis.