Welcome to the 164th FOAMed Quiz.
Question 1
Early recognition of necrotizing soft tissue infections is very important.
Point of care ultrasound (POCUS) can be a valuable tool for rapid identification of necrotizing soft tissue infections.
What are possible signs of a necrotizing soft tissue infection with POCUS?
A: Subcutaneous thickening, air / emphysema in the subcutaneous tissue, fascial fluid layer greater than or equal to 2mm, cobblestoning
B: Subcutaneous atrophy, air / emphysema in the subcutaneous tissue, fascial fluid layer greater than or equal to 2mm
C: Subcutaneous atrophy, fascial fluid layer smaller than or equal to 0.5mm, cobblestoning
D: Air / emphysema in the subcutaneous tissue, fascial fluid layer greater than or equal to 2mm, squish sign
The correct answer is A.
This week CoreEM covered POCUS in necrotizing soft tissue infections.
Ultrasound findings include:
– Subcutaneous thickening
– Air or emphysema in the subcutaneous tissue, which will appear as dirty shadowing – reverberation artifact from the interface where the air meets the tissue
– A fascial fluid layer greater than or equal than 2 mm
Squish sign is a movement of echogenic particles in response to compression, it is a sign of abscess.
Ultrasound Diagnosis of Necrotizing Soft Tissue Infections
Question 2
Idarucizumab (average costs 1.373,40 euro per ampule.. and you need 2) can be administered in life threatening hemorrhage in case the patient uses which of the following Direct Oral AntiCoagulants?
A: Edoxaban
B: Dabigatran
C: Rivaroxaban
D: Apixaban
The correct answer is B.
EMOttawa covered reversal of anticoagulants last week.
Idarucizumab is a monoclonal antibody which binds serum dabigatran with 350 times the affinity than dabigatran has for thrombin. Although expensive, the costs are similar to the costs of reversal by using four-factor prothrombin complex concentrate.
Question 3
Your 63 year old patient comes in with profound hypertension. Her blood pressure is 230 / 120. You perform fundoscopy and you find the following:
To which grade hypertensive retinopathy according to the The Keith-Wagener-Barker classification does this image correspond?
A: Grade 1
B: Grade 2
C: Grade 3
D: Grade 4
The correct answer is B.
Geekymedics covered hypertensive retinopathy last week.
The image above shows AV nicking and focal vasoconstriction, but no hemorrhages or cotton wool spots. Therefore is should be scored as a grade 2 hypertensive retinopathy.
Hypertensive Retinopathy
Question 4
Which of the following capnography waveforms suggests bronchospasm?
A:
B:
C:
The correct answer is B.
The basics of capnography were covered on Don’t Forget the Bubbles last week.
Image A is considered a normal capno wave.
In B, the plateau has not been reached during expiration before inspiration occurs. This is consistent with bronchospasm.
In C, a small depression during expiration suggests spontaneous respiratory effort.
A Beginner’s Guide to Capnography
Question 5
What is a typical presentation of ‘acute flaccid myelitis’?
A: Upper respiratory and/or gastro-intestinal symptoms 1-2 weeks preceding a rapidly progressive weakness of one or more extremities
B: Upper respiratory and/or gastro-intestinal symptoms 1-2 weeks preceding a gradual progressive weakness of one or more extremities
C: Upper respiratory and/or gastro-intestinal symptoms 3-4 weeks preceding a rapidly progressive weakness of one or more extremities
D: Upper respiratory and/or gastro-intestinal symptoms 3-4 weeks preceding a gradual progressive weakness of one or more extremities
The correct answer is A.
Pediatric EM Morsels discussed acute flaccid myelitis last week.
Acute flaccid myelitis is used for presentations similar to poliomyelitis, but without poliovirus being found. There is a rapidly progressive weakness (most often proximal) with a viral prodrome 1-2 weeks preceding the weakness. It is associated with infections with enteroviruses, coxsackieviruses, flaviviruses, herpesviruses and adenoviruses. Because of its rapid progression, patients need to be hospitalized to observe and treat respiratory distress.
Acute Flaccid Myelitis
This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Gijs de Zeeuw, Nicole van Groningen, Jeroen van Brakel, Noortje Geerts and Renée Deckers
Reviewed and edited by Rick Thissen
