Quiz 115, May 21th, 2021

Welcome to the 115th FOAMed Quiz.


Source image: www.cdc.gov

Question 1

Gonorrhea is one of the most common sexually transmitted diseases (STD). Hematogenous spread of Neisseria gonorrhoeae leads to systemic infection, called disseminated gonococcal infection (DGI).

What symptoms are part of the classic triad of DGI?

A: Tenosynovitis, arthritis and dermatitis

B: Perihepatitis, salpingitis and vaginal discharge

C: Arthritis, urethritis and conjunctivitis

D: Dermatitis, lymphadenopathy and fever

The correct answer is A.

This week, emDOCS discussed DGI.

It should be in your differential in patients (especially young adults) presenting with migratory polyarthralgia, arthritis, or tenosynovitis, in combination with skin lesions.
The other answers are all STD related; can you name the syndrome or disease?

Answer B is the triad of Fitz-Hugh-Curtis syndrome
Answer C is the triad of Reiter’s syndrome.
Answer D are symptoms of secondary syphilis.

Question 2

A 5 day old baby presents to your ED after vomiting bright red blood. This otherwise healthy baby had a normal birth. The past few days he was drinking normally and had a normal stool. You want to perform an Apt-Downey test.

Which of the following statements is true about the Apt-Downey test for neonatal hematemesis?

A: The Apt-Downey test is useful in children up 9 months of age

B: The Apt-Downey test is a test to distinguish neonatal from maternal blood

C: The Apt-Downey test relies on the fact that fetal hemoglobin is resistant to acid denaturation

The correct answer is B

Neonatal hematemesis can be terrifying for parents. Some benign causes can be easily detected with a simple test such as the Apt-Downey test.

Fetal hemoglobin is resistant to alkali denaturation and after centrifugation it should have a pink color due to free floating hemoglobin. If it turns yellow this means that it did denature and it is adult or maternal hemoglobin. The test should not be used in infants > 6 months. You need a ‘fresh’ bloody specimen and it should be tested within 30 minutes of collection. You can use stool or emesis but it has to contain bright red blood. 

Source image: www.brownemblog.com

Question 3

Your 65 year old patient presents after someone hit her in the right eye. Immediately afterwards, the patient complained about blurring and diplopia. You think she might have a traumatic lens dislocation. Unfortunately, in the meantime her eyelids are very swollen and you cannot visualize the eye anymore. You decide to use Point of Care Ultrasound (POCUS).

What is the sensitivity of POCUS for traumatic lens dislocation?

A: 65%

B: 75%

C: 85%

D: 95%

The correct answer is D.

BrownEM covered POCUS in traumatic eye injuries last week.

According to this prospective cohort study, POCUS has a sensitivity of 96.8% (95% CI 83.3% to 99.9%) in the diagnosis of lens dislocation, and a sensitivity of 95.7% (95% CI 78.1% to 99.9%) in the diagnosis of retrobulbar hematoma.

Source image: www.nysora.com

Question 4

Your patient presents with a pretty nasty wound on the lower leg. You want to perform an ultrasound guided popliteal sciatic nerve block.

The sciatic nerve bifurcates just above the popliteal fossa. Distal to the bifurcation two nerve trunks are visible on ultrasound.

These two trunks are called:

A: Tibial nerve and common peroneal nerve

B: Tibial nerve and sural nerve

C: Sural nerve and common peroneal nerve

D: Saphenous nerve and sural nerve

The correct answer is A

The sciatic nerve consists of two separate nerve trunks: the tibial and common peroneal nerves. A common paraneural sheath envelops these two nerves from their origin in the pelvis

A popliteal block results in anesthesia of the entire distal two thirds of the lower extremity, with the exception of the medial aspect of the leg.

Question 5

Source image: www.pixabay.com

A 70 day old infant presents to your ED with fever. The COVID test turns out positive. You wonder whether this means you can stop evaluating for serious bacterial infection (SBI).

This recently published retrospective study is about 53 COVID positive infants with fever and 53 matched COVID negative febrile infants. What did the authors conclude about the difference in rate of serious bacterial infection between the two groups?

A: The authors found the risk of SBI was much lower in COVID positive infants

B: The authors found the risk of SBI equal in COVID positive and COVID negative infants

C: The authors found the risk of SBI was much lower in COVID negative infants

The correct answer is A.

Clay Smith covered the paper last week on Journalfeed.

The authors found the risk of SBI (UTI, bacterial enteritis, bacteremia, or bacterial meningitis) was much lower in COVID positive infants versus COVID negative infants 8% vs 34%. The most common SBI was UTI.

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This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Gijs de Zeeuw, Nicole van Groningen and Joep Hermans

Reviewed and edited by Rick Thissen