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Dermatology · Infections: bacterial, viral, fungal, parasitic: danger triangle of the face
Sample itemA young man squeezes a boil beside his nose. Two days later he has high fever and a swollen, proptosed eye with restricted eye movements, and within a day the other eye also swells and he becomes drowsy. Which complication has occurred?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Cavernous sinus thrombosis
Veins of the central face drain through the angular and ophthalmic veins, which have no valves, into the cavernous sinus. Infected thrombus can therefore spread, and spread to the opposite eye with drowsiness points to cavernous sinus thrombosis, needing intravenous antibiotics.
Option by option
A. Cavernous sinus thrombosis (correct)
Correct. Bilateral spread, ophthalmoplegia and drowsiness after a nasal furuncle indicate thrombosis of the cavernous sinus.
B. Preseptal cellulitis
Preseptal cellulitis causes lid swelling without proptosis or restricted eye movement.
C. Orbital cellulitis
Orbital cellulitis is unilateral and does not usually cross to the opposite eye or cause drowsiness.
D. Acute dacryocystitis
Dacryocystitis is a painful swelling at the medial canthus over the lacrimal sac.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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