Quiz 153, May 6, 2022

Welcome to the 153th FOAMed Quiz.


Question 1

Source image: www.emra.org

Patients often report that a peripheral intravenous catheter (IV) should not be placed on the same side of the body as prior breast surgery.

In this 2021 retrospective paper a chart review was performed on 3724 patients with prior surgery for breast cancer. These patients underwent 7896 IV placements. The IVs were being placed a median of 1.5 years after the original breast cancer surgery. 5153 were placed in the ipsilateral arm and 2743 were placed in the contralateral arm.

What did the authors find?

A: More complications were found in patients with an IV in the ipsilateral arm

B: More complications were found in patients with an IV in the contralateral arm

C: There were only 2 complications in both groups

The correct answer is C.

The paper was covered on First10EM last week.

Indeed, there were only 2 complications in both groups. Prior breast surgery is not a contra-indication for IV placement on the ipsilateral side. However, it may take some gentle discussion with the patient due to the misinformation they have received.

Research Roundup (May 2022)

Question 2

Source image: www.pixabay.com

Your 35 year old patient is brought in after a fire in his living room. He inhaled a lot of smoke. He is profoundly tachypneic, confused and has a lactate of 16 mmol/L. You want to treat him for cyanide intoxication.

Which of the following agents is first line treatment in cyanide intoxication?

A: Amyl nitrite

B: Sodium nitrite

C: Sodium thiosulfate

D: Hydroxocobalamin

The correct answer is D.

Carbon mono-oxide and Cyanide poisoning were covered on NuEM last week.

Historically, amyl nitrite or sodium nitrite in combination of sodium thiosulfate was used for cyanide intoxication. These days the first line treatment is high dose Hydroxocobalamin (5 grams). Hydroxocobalamin scavenges cyanide by binding it to form cyanocobalamin.

Question 3

Source image: lermagazine.com

Your patient presents with a lower leg fracture and is in extreme pain. You wonder whether he has compartment syndrome and decide to measure compartment pressure.

What is the generally accepted compartment pressure above which the diagnosis becomes very likely?

A: > 10 mmHg

B: > 20 mmHg

C: > 30 mmHg

The correct answer is C

RebelEM covered compartment syndrome last week.

The diagnostic threshold for compartment syndrome is 30 mmHg.

REBEL Core Cast 80.0 – Compartment Syndrome

Question 4

Source image: www.pixabay.com

To anesthetize the sole of the foot (for example in removal of foreign objects), ultrasound guided nerve blocks are very useful.

A block of which of the following nerves results in anesthesia of the largest part of the sole of the foot?

A: Posterior tibial nerve

B: Saphenous nerve

C: Sural nerve

The correct answer is A. 

Ultrasound guided posterior tibial nerve block was covered on Core Ultrasound last week.

A posterior tibial nerve block will anesthetize most of the sole of the foot.

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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