Quiz 160, July 1, 2022

Welcome to the 160th FOAMed Quiz.


Question 1

The electrocardiogram shown above belongs to a 7 year old boy who suddenly collapsed during exercise. It is an example of a Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT).

Which of the following statements about CPVT is NOT true?

A: Children between the ages of 7 – 9 years are mostly affected by CPVT, but it also occurs in children under 2 years old. It is uncommon in children older than12 years

B: CPVT is induced by physical or emotional stress

C: If CPVT is not timely diagnosed and treated, it has a mortality rate of up to 35%

D: CPTV occurs in an anatomically and structurally normal heart

E: Patients with CPVT typically have a normal baseline ECG

The correct answer is A

Critical Care Now covered CPVT last week.

Children between the ages of 7 and 9 years are most commonly affected, but it also occurs in children up to 12 years old. It is rare in children less than 2 years old.

Obtaining a family history in these patients is extremely important because thirty percent of patients have family history positive for exercise-induced syncope, seizure or sudden death.

Many patients are initially misdiagnosed as having vasovagal syncope or epilepsy. The most common presentation is syncope during exercise.

Patients with CPVT typically have an anatomically and structurally normal heart and a normal baseline ECG.

Catecholaminergic Polymorphic Ventricular Tachycardia: Recognize And Treat It Early

Question 2

Source image: pixabay.com

Your patient presents with a swan neck deformity of his right index finger.

Rupture of which of the following structures typically causes a swan neck deformity?

A: Terminal extensor tendon

B: Central band of the extensor tendon

C: Flexor digitorum profundus (FDP)

D: Flexor digitorum superficialis (FDS)

The correct answer is D

AliEM covered finger injuries last week.

A swan neck deformity is caused by rupture of the FDS.

Rupture of the FPD causes inability to flex in the distal interphalangeal joint.

Central band rupture causes Boutonniere’s deformity.

Rupture of the terminal extensor tendon causes a mallet finger.

SplintER Series: Stop! Hammer Time

Question 3

Which of the following mushrooms would you choose to eat (assuming you are not suicidal)?




The correct answer is B.

Morel mushrooms and their imposters were covered on Taming the SRU last week.

A morel mushroom (B) exhibits a spongy, porous labyrinth of deeply-ridged craters and pits. It is completely hollow on the inside.

Its imposter, Gyromitra (A), appears rufous, mahogany, or crimson – colored and are not hollow on the inside. It contains gyromitrin, which is hydrolyzed into monomethylhydrazine (MMH), which reacts with pyridoxal phosphate. A lack of pyridoxal phosphate (active form of vitamin B6) results in cessation of production of GABA and as you can image, this causes seizures and overall badness.

Number C is called Autumn Skullcap (cute name) and contains amatoxins, causing gastrointestinal and hepatotoxic problems, coma, and death.

Question 4

Source image: ecg-interpretation.blogspot.com

An eldery male patient presents to the ED with new-onset chest pain since a couple of hours. The patient had a long history of smoking, but no prior history of heart disease. His ECG is shown above.

Which of the following coronary arteries was most likely to be occluded?

A. Right coronary artery (RCA)

B. Left Main (LCA)

C. Left anterior descending artery (LAD)

D. Left circumflex artery (LCX)

Correct answer is C

This ECG and case was covered by Ken Grauer on ECG interpretations last week.

The ECG shows a huge ongoing STEMI. There are ST elevations in 9 out of 12 leads, most dominant in leads V2-V6. This suggests either acute proximal LAD occlusion or Left main occlusion (LCA). Unfortunately, in this case the patient died before cardiac catheterization could be performed. The culprit lesion is most likely to be found in the proximal LAD, since the patient survived another 1-2 hours after presentation which is not very common in a complete Left Main obstruction.

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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