Quiz 152, April 29th, 2022

Welcome to the 152th FOAMed Quiz.


Source image: theultrasoundsite.co.uk

Question 1

Your 75 year old patient presents with arthritis of his knee. Which of the following sonographic signs is typically found in gout?

A: Banana sign

B: Whirlpool sign

C: Falling snow sign

D: Double contour sign

The correct answer is D.

The role of ultrasonography in the diagnosis of gout was discussed on BrownEM last week.

The double contour sign is a hyperechoic irregular or linear enhancement parallel to the subchondral bone. However, this can also be present in calcium pyrophosphate deposition disease (pseudogout).

The banana sign is seen in Chiari II malformation in the fetus.

The whirlpool sign is seen in midgut volvulus (or ovarian or testicular torsion).

The falling snow sign is seen in spermatocele.

Source image: www.healthline.com

Question 2

Which of the following drugs generally does not cause a positive standard opioid urine drug screen test?

A: Oxycodone

B: Heroin

C: Morphine

D: Codeine

The correct answer is A.

Opioid drug screening was covered on AliEM last week.

Heroin and codeine are metabolized to morphine and generally cause a positive drug screen test. (semi) Synthetic opioids like oxycodone might not cross react and frequently do not cause a positive test. However, oxycodone can be tested in another essay.

Interpretation and Limitations of Opiate Urine Drug Tests

Source image: avssuk.co.uk

Question 3

In which of the following injuries can the saline load test be useful?

A: Pneumothorax

B: Liver injury

C: Shoulder dislocation

D: Traumatic arthrotomy

The correct answer is D.

Traumatic arthrotomy was covered on NUEM last week.

The saline load test is done by performing an arthrocentesis of the affected joint away from laceration. Once confirmed in the correct space, sterile saline is injected into the joint and the laceration site is observed for extravasation.

Source image: emottawablog.com

Question 4

Which of the following treatment options is NOT considered first line in pericarditis?


B: Corticosteroids

C: Colchicine

The correct answer is B.

Pericarditis and myocarditis were covered on EMOttawa last week.

NSAIDs (ibuprofen or acetylsalicylic acid) and colchicine are first line treatment options for acute pericarditis. Corticosteroids are not.

Pericarditis and Myocarditis in the ED

Source image: anatomytool.org

Question 5

Aortic dissection is a life threatening condition that is often hard to diagnose. POCUS has been reported to have low sensitivity, but it can make this diagnosis more likely whenever abnormalities are found.

Choose between the following options to form a correct statement about the aortic root on POCUS.

The aortic root is best measured in the (A) ….. at the level of (B)….. at the end of (C)….. and should not be larger than (D)…. in diameter.

A: Parasternal long axis view / Parasternal short axis view

B: Aortic annulus / sinus of valsalva

C: Systole / Diastole

D: 3.5cm / 4.5cm

The correct answer is:
The aortic root is best measured in the parasternal long axis view at the level of the sinus of valsalva at the end of the diastole and should not be larger than 4.5 cm in diameter.

This week Taming the SRU discussed aortic dissection.

POCUS can be useful for rapid assessment of aortic dissection complications: aortic root dilatation, aortic regurgitation, pericardial effusion and hemothorax. Remember that the negative predictive value is (very) low.

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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