Quiz 148, March 11, 2022

Welcome to the 148th FOAMed Quiz.


Source image: www.pixabay.com

Question 1
Your 35 year old patient presents with bilateral facial palsy, diplopia and descending muscle weakness. He states he had a barbeque yesterday. His vital signs are normal, he has no fever and he denies any gastro-intestinal complaints or headache.

Which of the following foodborne illnesses fits the picture best?

A: Ciguatera

B: Botulism

C: Salmonellosis

D: Scombroid

The correct answer is B.

Botulism was covered on EMDocs last week.

Cranial nerve dysfunction and descending muscle weakness are typical for botulism. Respiratory difficulties often require intubation and mechanical ventilation. Nonspecific gastrointestinal (GI) symptoms may be present.

Source image: www.ahajournals.org

Question 2

Electrical cardioversion of atrial fibrillation is often performed in the ED. The defi pads can be placed either anterior-posteriorly and anterior-laterally.

In this recently published RCT468 patients undergoing elective cardioversion for atrial fibrillation were randomized to either anterior-posterior or anterior-lateral pads placement.

What placement was associated with a higher rate of conversion to sinus rhythm at the first attempt?

A: Anterior-lateral pads placement

B: Anterior-posterior pads placement

C: The rate was equal between the two groups

The correct answer is A.

JournalFeed covered the paper last week.

The authors found that after the first shock, 54% of patients in the anterior-lateral group vs 33% of patients in the anterior-posterior group converted to sinus rhythm (95% CI, 13-30; P<0.001).

Source image: www.morancore.utah.edu

Question 3

Your 22 year old patient comes in after a blow to the right eye. He has grade III hyphema.

Which of the following symptoms should certainly warrant emergent ophthalmic referral (2 correct answers)?

A: Blurred vision

B: Elevated intraocular pressure (IOP)

C: Corneal abrasion

D: Associated globe rupture

The correct answers are B and D.

AlieEM covered hyphema last week.

Emergency consultation of an ophthalmologist is certainly warranted in case of elevated IOP and globe rupture. Blurred vision is always present in high grade hyphema. 

SAEM Clinical Image Series: Snowball Effects

Source image: www.pixabay.com

Question 4

Your patient presents after being stung in the ocean by ‘some sort of animal’. He is in severe pain.

In what case might an X-ray help you in the management of this patient?

A: Stingray attack

B: Coral wound

C: Stonefish sting

D: Sea urchin injury

The correct answer is D.

NuEM covered marine envenomations last week.

The spines of sea urchins are often visible in X-rays, giving you an indication about the job ahead.

In general marine venoms are heat labile and hot water submersion should be commenced as soon as possible, although evidence for hot water submersion is not as clear as it is for jellyfish injury.

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

Reviewed and edited by Rick Thissen