Quiz 159, June 24th, 2022

Welcome to the 159th FOAMed Quiz.


Source image: www.alodokter.com

Question 1

For some reason, Ramsay Hunt syndrome is all over the news these days.

As we all know by now, this is a peripheral facial paralysis. But how does it compare to the (formerly) more famous Bell’s Palsy?

Which of the following statements is NOT true?

A: Ramsay Hunt syndrome has a worse prognosis than Bell’s Palsy

B: Dizziness is a more common complaint in Ramsay Hunt syndrome than in Bell’s Palsy

C: Both in Ramsay Hunt syndrome and Bell’s Palsy, an erythematous vesicular auricular skin rash is often seen preceding paralysis

D: Antiviral therapy is a cornerstone in treating Ramsay Hunt syndrome, but has no evidence based benefit in Bell’s Palsy

The correct answer is C.

This week, Ramsay Hunt syndrome was discussed by Pediatric EM Morsels.

Ramsay Hunt syndrome is caused by reactivation of Varicella Zoster Virus. This leads to an auricular skin rash, which is not typically seen in Bell’s Palsy. Ramsay Hunt syndrome is described as more painful. Both Ramsay Hunt syndrome and Bell’s Palsy affect CN VII, but the first can also affect CN VIII, leading to vestibular symptoms, not typically seen in Bell’s Palsy.

Pediatric Ramsay Hunt Syndrome

Source image: www.rebelem.com

Question 2

While COVID-19 causes yet another surge in Europe, we hope to avoid the next overload of our critical care system.

The benefit of awake proning of our ill COVID patients has been uncertain and it was surely not general practice in our hospital.

Last month the COVI-PRONE trial was published. 400 patients (of which 97% had confirmed COVID-19) were randomised to either awake prone positioning (targeted for 8 hours daily) and usual care without prone positioning. These patients were not intubated and required oxygen (≥40%) or noninvasive ventilation.

The primary outcome was endotracheal intubation within 30 days of randomisation.

What did the authors find?

A: Patients in the awake proning group had statistically significant lower rates of intubation

B: Patients in the standard group had statistically significant lower rates of intubation

C: There was no difference in intubation rate between the two groups

The correct answer is C.

RebelEM covered the paper last week.

The achieved medial duration of prone positioning of the patient was 4.8 hours per day.

There was no statistically significant difference in intubation rate between the two groups. However, the rate of intubation was 34.1% in the awake proning group compared to 40.5% in the usual care group. This is a rather big difference, and the study just might be underpowered to detect a statistically significant difference.

REBEL Cast Ep110: The COVI-PRONE Trial – Awake Prone Positioning and COVID-19

Source image: www.pixabay.com

Question 3

Which of the following bacteria causes about 1/3th of cases of Lemierre’s syndrome?

A: Staphylococcus aureus

B: Fusobacterium necrophorum

C: Streptococcus pyogenes

D: Pseudomonas aeruginosa

The correct answer is B.

EMDocs covered Lemierre’s syndrome last week.

Lemierre’s syndrome is one of the ENT emergencies we should always consider in a patient with severe pharyngitis.

Lemierre’s syndrome is a suppurative thrombophlebitis of the internal jugular vein

Fusobacterium necrophorum accounts for about 33 percent of cases of Lemierre’s syndrome.


Source image: www.lompocvmc.com

Question 4

The foramen of Monro connects which two cerebrospinal fluid (CSF) containing structures?

A: The two lateral ventricles only

B: The lateral ventricles and the third ventricle

C: The third ventricle and the fourth ventricle

D: The fourth ventricle and the cisterna magna

The correct answer is B.

Geeky Medics covered anatomy of the cerebrospinal fluid filled structures last week.

The interventricular foramina (or foramina of Monro) connect the lateral ventricles to the third ventricle.

CSF exits the fourth ventricle via three foramina (Magendie and Luschka) into the cisterna magna.

The Ventricular System

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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