Quiz 169, November 25th, 2022

Welcome to the 169th FOAMed Quiz.


Question 1

Source image: www.grepmed.com

In ophthalmology there are only a few, but serious emergency diagnoses. One of these is orbital compartment syndrome (OCS). Signs of an OCS include diminished visual acuity, relative afferent pupillary defect (RAPD) and reduced colour vision.

Which of the following statements is true?

A: Before treatment is initiated, it is essential to perform a CT-scan

B: In case of signs of OCS, one should not wait for imaging before treatment

C: OCS generally does not require treatment

The correct answer is B.

Geeky Medics covered eye trauma last week.

In case of an OCS, direct intervention is required in the form of lateral canthotomy and cantholysis. Any delay in treatment due to waiting for imaging may cause irreversible sight loss. If there are no problems with the patient’s vision yet, frequent monitoring of visual acuity, pupils and intraocular pressure during the first 6 to 8 hours is vital to detect a deterioration early.

Eye Trauma

Question 2

Source image: www.medindia.net

Methemoglobinemia (MetHb) can cause a variety of symptoms depending on the level of MetHb. Methemoglobinemia can be caused by a variety of drugs.

Which of the following does not cause methemoglobinemia?

A: Isobutyl Nitrite (also called “poppers”)

B: Benzocaine

C: Ondansetron

D: Nitrofurantoin

The correct answer is C

The diagnosis and treatment of methemoglobinemia was discussed on RebelEM last week.

Dapsone and topical anaesthetic agents (i.e. benzocaine) are the most common medications that cause methemoglobinemia. Isobutyl nitrite is probably the most common cause of methemoglobinemia in the Emergency Department. The pathophysiology is based on oxidation of the iron in the haemoglobin molecule.

REBEL Core Cast 90.0 – Methemoglobinemia

Question 3

Source image: www.renalfellow.org

POCUS is a valuable diagnostic tool for suspected right heart failure.

Which of the following signs supports the diagnosis of right heart failure:

A: Right ventricle (RV) free-wall thickness of 4 mm

B: Inferior vena cava (IVC) diameter of 9 mm

C: Tricuspid annular plane systolic excursion (TAPSE) of 14 mm

D: Right ventricle to left ventricle ratio of 0.6

The correct answer is C.

This week emDocs covered diagnosis of right heart failure in the Emergency Department.

A right ventricle free wall of less than 5 mm is considered normal, as well as a right ventricle to left ventricle ratio of 0.6. A IVC diameter of only 9 mm suggests no elevated right ventricular pressure. A TAPSE of less than 20 mm is consistent with reduced right ventricular function.

Right Heart Failure in the ED: Approach to Diagnosis and Management

Question 4

Source image: www.ppemedical.com

In laceration repair, we are taught that eversion of wound edges leads to improved cosmesis.

What does the available evidence say?

A: Plenty of evidence concludes wound edge eversion indeed leads to improved cosmesis

B: No evidence is available on this subject

C: There is very little evidence available, but the evidence suggests wound edge eversion does not lead to improved cosmesis

The correct answer is C.

Justin Morgenstern covered wound edge eversion on First10EM last week.

He concludes: ´There is very little evidence to guide us, but the necessity of eversion in wound repair seems to fall into the medical dogma camp.’

Laceration repair: Does eversion matter?

Question 5

Source image: www.cigna.com

Which of the following statements is true regarding necrotising enterocolitis (NEC)?

A: It is most likely to occure in neonates born postterm (after 42 weeks)

B: All neonates with NEC require surgical intervention

C: NEC has an 80 percent mortality rate

D: Severity of the disease is scored by the modified Bell’s staging criteria

The correct answer is D.

Don’t forget the Bubbles covered the distended abdomen in neonates last week.

NEC occurs when sections of bowel tissue undergo inflammation leading to bacterial invasion and necrosis.

About 90 percent of NEC patients are born preterm. The mortality rate is 20 – 40 percent. Approximately 1 in 4 infants with NEC require surgery.

The modified Bell’s staging criteria can be used to determine the severity of the disease.

An approach to distended abdomens in neonates

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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