Quiz 130, September 24th, 2021

Welcome to the 130th FOAMed Quiz.

 

Question 1

Source image: wolverem.com

Which of the following is not a sign of orbital compartment syndrome?

A: Positive Seidel test

B: Proptosis

C: Marcus-Gunn pupil

D: Decreased visual acuity

The correct answer is A.

Orbital compartment syndrome was covered on AliEM this week.

Signs of orbital compartment syndrome include:
– Proptosis
– Increased intraocular pressure
– Marcus-Gunn pupil
– Decreased visual acuity
– Restricted ocular movements

A Marcus-Gunn pupil is caused by a relative afferent pupillary defect (RAPD).

A positive Seidel test is seen in case of globe rupture

SAEM Clinical Image Series: Traumatic Swollen Eye

Question 2

Your 19 year old patient presents to your ED after recurrent episodes of syncope. His father died suddenly at the age of 32 without a known cause. On your patients ECG to see inverted T-waves in V1-5.

Sourrce image: litfl.com

Which of the following waves are visible on his ECG?

A: Delta wave

B: Osborn wave

C: Epsilon wave

The correct answer is C.

A case of Arrhythmogenic right ventricular cardiomyopathy (ARVC) was covered on dr. Smith’s ECG blog this week.

This patient most likely suffers from ARVC. Epsilon waves (Small positive deflection at the end of the QRS) are seen in about a quarter of patients with ARVC.

Question 3

Source image: www.proceduresconsult.jp

Your patient comes in with a plantar sole laceration.

Which of the following ultrasound guided nerve blocks is best used in this case?

A: Femoral nerve block

B: Ischiadic nerve block

C: Posterior tibial nerve block

D: Saphenous nerve block

The correct answer is C.

Jacob Avila and Arun Nagdev covered various ultrasound guided procedures this week on core-ultrasound.

For this indication, a posterior tibial nerve block is indicated. It will provide anesthesia to almost the entire sole of the foot.

Nerve Block Talks Episode 3!

Question 4

Source image: www.acc.org

Which of the following statements is true about using ultrasound for detection of regional wall motion abnormalities (RWMA) in suspected occlusion myocardial infarction (OMI)?

A: RWMA is a relatively late finding in OMI

B: Besides OMI, myocarditis can cause RWMA as well

C: Data clearly shows emergency care physician performed assessment for RWMA has a high sensitivity for OMI

D: On the parasternal short axis view, the cardiac wall nearest to the top of the screen is supplied by the right coronary artery

The correct answer is B.

The performance of ultrasound assessment of RWMA in myocardial infarction was covered on CountyEM this week.

RWMA occurs very quickly after occlusion of a coronary artery, even before ECG changes and pain.

Focal myocarditis causes RWMA.

The sensitivity of emergency care physician performed assessment for RWMA for detection of OMI is yet unknown.

On the parasternal short axis view, the cardiac wall nearest to the top of the screen is the anterior wall which is supplied by the LAD.

Can Ultrasound Diagnose Myocardial Infarction?

Question 5

Source image: caperadiology.co.za


CT coronary angiography (CTCA) is an anatomic study that tells us about the presence and extent of coronary artery disease (CAD).

In theory, CTCA might help us risk stratify patients with chest pain in the ED.

According to available literature, what does CTCA lead to if used in patients with chest pain in the ED?

A: CTCA leads to more accurate identification of CAD

B: CTCA leads to less coronary angiography

C: CTCA leads to a reduction in mortality at 6 months

D: CTCA leads to shorter duration of stay in the ED

The correct answer is A.

A review of available literature on CTCA in the ED was posted on RebelEM this week.

‘’CTCA can help optimize medical management but doesn’t change long term patient-oriented outcomes compared to optimal medical treatment alone.’’

Rebellion21: Approach to Angina in 2021 via Tarlan Hedayati, MD

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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