Which of the following is the first-line treatment for cutaneous and visceral leishmaniasis?
A) Chloroquine
B) Sodium stibogluconate
C) Metronidazole
D) Amphotericin B
Which vitamin can cause birth defects if taken in high doses during pregnancy?
A) Vitamin A
B) Vitamin C
C) Vitamin D
D) Vitamin K
Hint: Both deficiency and excess of some vitamins can be harmful during pregnancy.
Which of the following is the most common associated factor in temporalis muscle hypertrophy?
A. Bruxism (teeth grinding)
B. Hyperthyroidism
C. Bell's palsy
D. Migraine
Answer: Pacemaker pocket infection with device erosion/exposure.
What’s Happened?
This is a permanent pacemaker (or ICD) generator pocket infection that has progressed to skin erosion and device extrusion — one of the most serious and feared complications of cardiac implantable electronic devices (CIEDs).
The metallic device (generator) is visibly exposed through an open, inflamed wound in the subclavicular pocket.
Surrounding skin shows erythema, induration, and breakdown.
Leads/wires are also visible in the wound.
This is typically caused by bacterial infection (often Staph aureus or coagulase-negative staphylococci), which can track along the leads.
Why "Most Feared"?
High risk of systemic infection, endocarditis, sepsis.
Almost always requires complete device and lead extraction (not just antibiotics).
Re-implantation on the opposite side after infection clearance.
Significant morbidity, prolonged hospital stay, and higher mortality if not managed promptly.