A 4-month-old girl is brought by her concerned mother because the child has been inconsolably crying for 6 hours. The child is breast fed and has been doing well. There is no vomiting, diarrhea, constipation, or increased gas. The mother has not changed her diet and the infant is on no medications. There has been no fever. On physical examination the child is active and screaming. There is no fever. The physical examination is normal except that there is redness and swelling affecting the left third toe with indentation proximal to the redness. It is tender to touch. There was no history of similar problems. The picture is shown below: 
The most likely working diagnosis:
A. Trauma
B. Herpetic whitlow
C. Hairy tourniquet syndrome
D. Acute paronychia
E. Ingrown toe nail
F. Acute Gout
The most appropriate next step in management :
A. Joint aspiration
B. X-ray of the foot
C. Inspect the toe for hair strangulation
D. Incision and drainage
E. Topical acyclovir
Filed under: USMLE Test Prep |
Archer USMLE Step 3 Blog 
C and C
C C
ans1:c
2:c
CC