Quiz 158, June 17th, 2022

Welcome to the 158th FOAMed Quiz.


Source image: www.venousforum.org

Question 1

Which of the following ECG abnormalities is NOT caused by pulmonary embolism?

A: Atrial fibrillation

B: New tall R-wave in V1

C: ST elevation in lead aVR

D: Peaked and pointed P waves in lead I and aVL

The correct answer is D.

Ken Grauer covered ECG abnormalities in pulmonary embolism last week.

Possible EC changes due to pulmonary embolism include:
– Sinus tachycardia
– Signs of RV strain
– S1Q3T3 pattern
– Right atrial enlargement (peaked and pointed p waves in II, III, aVF, V1 and V2
– Right axis
– New tall R-wave in V1
– ST elevation in lead aVR
– Atrial fibrillation

Source image: www.nursing.nl

Question 2

Which of the following clinical features is NOT typical for monkeypox?

A: Lymphadenopathy

B: Acute onset of rash

C: Dermatomal distribution

D: Back pain

The correct answer is C.

Geeky Medics covered monkeypox last week.

Typical clinical features of monkeypox include: acute rash accompanying either headache, acute onset fever, lymphadenopathy, myalgia, back pain and asthenia.

If the rash follows a dermatomal distribution, consider shingles.


Source image: https://radiopaedia.org

Question 3

Your patient was dropped and left outside of your emergency department. He is hemodynamically unstable, diaphoretic and has an altered level of consciousness. He states he is a body stuffer and he is transporting an unknown substance.

What is the difference between a body packer and a body stuffer?

A: A body packer usually ingests about 1 kilogram of drugs, whereas a body stuffer ingests as much as possible

B: A body packer ingests drug packets and a body stuffer hides drug packets in various orifices

C: In a body packer, ingestion of drug packets is well coordinated, whereas a body stuffer swallows drugs in a hurry

The correct answer is C.

EMDocs covered body packers, stuffers and pushers last week.

In a body packer, ingestion of drug packets is well coordinated, whereas a body stuffer swallows drugs in a hurried fashion (often to avoid immediate arrest). The packets are often more prone to break. The amount of drugs is usually smaller in body stuffers.

A person who hides drug packets in various orifices is called a body pusher.

Body Packers, Stuffers, and Pushers: Time Bombs in Our EDs

Question 4

In the images above. The blue area is supplied by which artery?


B: Cx


The correct answers is C.

 Jacob Avila covered advanced cardiac ultrasound last week on Core Ultrasound.

The blue area is supplied by the RCA, the yellow area by the LAD, the red area by the LAD or Cx and the green area by the RCA or Cx. 

5 Top Tips for Advanced Echo

Source image: https://my360pt.com

Question 5

Unilateral pain that radiates along the path of the sciatic nerve, from the lower back through the hip and buttock towards the leg is typical for sciatica. Ultrasound guided sciatic nerve block may be beneficial for patients with sciatica. A long-acting anesthetic such as bupivacaine, in combination with a corticosteroid may provide pain relief.

Which of the following statements about the anatomy of the sciatic nerve is true?

A: It runs between the ischial tuberosity and greater trochanter

B: It runs above the gluteus maximus and below the quadratus femoris muscles

C: It runs within a fascial plane through the obturator foramen

D: Distally it branches in the saphenous nerve

The correct answer is A.

This week AcepNow discussed The ultrasound-guided transgluteal sciatic nerve block (TGSNB).

The sciatic nerve is identified by ultrasound located inferior to the gluteus maximus muscle, superior to the quadratus femoris muscle as it courses adjacent to the ischial tuberosity (medially) and greater trochanter (laterally).

TransGluteal Sciatic Nerve Block

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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