Christmas edition, December 26th 2019

Welcome to the Christmas Special

Merry Christmas and a Happy New Year!

Enjoy!

Kirsten, Eefje, Hüsna, Joep and Rick

Which eponyms are we looking for???

Question 1

 
Source image: http://www.emdocs.net/

M

The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. It is named after Giovanni Battista Monteggia.

EM Cases – Elbow Injuries – Ten Pitfalls in Diagnosis and Management

Question 2

Source Image: http://www.surgeryassistant.nl/

E

An Essex-Lopresti injury consists of a radial head fracture with dislocation of the distal radioulnar joint (DRUJ) and disruption of the interosseous membrane (IOM).

Essex-Lopresti fracture

Question 3

”Aspirin has been linked with this syndrome, so use caution when giving aspirin to children or teenagers for fever or pain. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.’ (Mayoclinic)

R

Reye’s Syndrome was first describe in 1963. It may occur at any age in childhood, although higher rates in children < 2 years of age. Death occurs in ~30-40% of cases due to brainstem dysfunction. The etiology is not clearly known. An association (although not clear causality) is described between recent viral illness and aspirin therapy.

Reye’s Syndrome

Question 4

Fundoscopy revealed these ‘spots´ in a patient with suspected endocarditis:

Source image: https://litfl.com/

R

Roth spots are retinal haemorrhages with white or pale centres, commonly associated with subacute bacterial endocarditis and immune complex mediated vasculitis.”

Roth spots

Question 5

Source image: https://www.emsstuff.com/

Y

Yankauer suction tip. Doesn’t need a lot of explanation, but I couldn’t think of anything else starting with a Y.

Sidney Yankauer

Question 6

”This disease is also known as American trypanosomiasis, is a tropical parasitic disease caused by the protist Trypanosoma cruzi. It is spread mostly by insects known as Triatominae.”’ 

C

”’ Chagas disease is an inflammatory, infectious disease caused by the parasite Trypanosoma cruzi, which is found in the feces of the triatomine (reduviid) bug. Chagas disease is common in South America, Central America and Mexico, the primary home of the triatomine bug. ”

https://www.cdc.gov/parasites/chagas/index.html

Question 7

A 9 year old male presents to your emergency department with a chief complaint of abdominal pain. 

Source image: https://www.wolverem.com/

H

Henoch–Schonlein Purpura (HSP) is an immune-mediated small vessel vasculitis. Compared to purpura commonly caused by thrombocytopenia, the etiology of the purpuric lesions in HSP are secondary to IgA-mediated immune complex deposition in the skin.

PEM Pointers: Henoch-Schonlein Purpura

Question 8

Source image: https://www.aliem.com/

R

Rolando Fracture is a complete and comminuted intraarticular fracture, usually in a T or Y shape

SplintER Series: Case of a First Metacarpal Fracture

Question 9

This is a system of categorizing scapula fractures involving the glenoid fossa.

Source image: https://www.orthobullets.com/

I

The Ideberg classification is a system of categorizing scapula fractures involving the glenoid fossa.

https://www.orthobullets.com/trauma/1013/scapula-fractures

Question 10

A 55 years old patient comes in with a rash after starting with ibuprofen for a backache 5 days ago. 

Source image: https://my.clevelandclinic.org/

S

Stevens-Johnson Syndrome (SJS) is a rare type IV hypersensitivity reaction with sheet-like skin loss and mucosal ulceration.

https://em3.org.uk/foamed/3/6/2019/lightning-learning-stevens-johnson-syndrome

Question 11

A 12-year old boy comes in with an ankle sprain.

Source image: https://litfl.com

T

A Tillaux Fracture is a fracture of the anterolateral tibial epiphysis commonly seen in adolescents. (Salter-Harris III tibial fracture)

Tillaux fracture

Question 12

A 60 years old patient comes in with fever and upper belly pain. You find this on POCUS and pressing the probe hurts. What is this sign called?

Source image: https://westjem.com

M

(Sonographic) Murphy’s Sign is positive when the maximal intensity of patient’s pain is when the gallbladder is in view directly beneath the probe.

https://www.nuemblog.com/biliary

Question 13

”If a patient’s hand flushes fully and rapidly after an artery is released, that artery, the palmar arch, and the digital arteries are patent. If pallor persists throughout the hand, the artery that was released is occluded. Pallor in patches indicates insufficiency of the smaller vessels.”

Source image: https://www.handsurgeryresource.com/

Question 14

Source image: https://litfl.com

S

A Segond Fracture is an avulsion fracture (small) of the lateral surface of the lateral tibial condyle. Usually results from excessive internal rotation and varus stress resulting in increased tension on the lateral capsular ligament of the knee joint.

Segond fracture

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This quiz was written by Eefje Verschuuren, Kirsten van der Zwet, Hüsna Sahin and Joep Hermans

Reviewed and edited by Rick Thissen

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