Quiz 171, December 9, 2022

Welcome to the 171th FOAMed Quiz.


Question 1

Source image: saem.org/

Your 10 year old male patient presents with unilateral scrotal pain for 26 hours. He denies trauma and fever, but he vomited a couple of times.

You suspect testicular torsion.

Which of the following statements is true regarding diagnosis and management of this patient?

A: Emergent surgical exploration is not indicated, for the testicle will not survive after 24 hours anyway

B: Presence of flow on doppler ultrasound excludes testicular torsion

C: If manual detorsion is successful, your patient can be discharged and required outpatient follow up in 1 week

D: When treated promptly by surgical exploration, the chance of survival of the testicle is still about 7 percent

The correct answer is D.

Testicular torsion was covered on RebelEM last week.

A systematic review demonstrates a 7.4 percent survival rate between 24 and 48 hours.
Presence of flow on doppler ultrasound does not reliably exclude testicular torsion.
Regardless of the success of manual detorsion, all patients will require surgical evaluation.

REBEL Core Cast 91.0 – Testicular Torsion

Question 2

Source image: resources.wfsahq.org/

Your 87 year old patient presents with a femoral neck fracture. She is in severe pain and you decide to perform an ultrasound guided nerve block.

In which of the following blocks, the local anesthetic should be injected deep to the psoas tendon?

A: Fascia Iliaca Compartment Block (FICB)

B: Femoral nerve block (FNB)

C: Pericapsular Nerve Group (PENG) block

The correct answer is C. 

EMDOcs covered nerve blocks in hip fractures last week.

There are 3 nerves that innervate the proximal femur. These are the femoral nerve, the obturator nerve and the accessory obturator nerve. The PENG block is thought to target these three nerves best. When performing a PENG block, the local anesthetic should be injected deep to the psoas tendon.

Ultrasound-Guided Regional Anesthesia for Hip Fractures

Question 3

Source image: www.tamariaclinic.com

Your patient presents with severe vulvar pain and she notices a swelling near her vagina.

In what location would you expect to find a Bartholin’s abscess in regard to the vaginal opening?

A: At 12 o’clock

B: At 2 o’clock

C: At 4 o’clock

D: At 6 o’clock

The correct answer is C.

Bartholin’s abscess was covered on EM@3AM last week.

Bartholin’s glands are pea-sized and located bilaterally at the 4 o’clock and 8 o’clock positions of the introitus.

EM@3AM: Bartholin’s Abscess

Question 4

Source image: www.pfcla.com

 A woman with suspected ovarian torsion presents to your ED.

Which of the following statements is true about ovarian torsion?

A: Ovarian torsion affects women below 50 years of age only

B: Most patients have a cyst or mass >5 cm

C: The majority of patients present with fever

D: Nausea and vomiting is rare in patients wth ovarian torsion

The correct answer is B.

Ovarian torsion was covered on emDOCs last week.

Women of all ages can have ovarian torsion. 15% of cases occur during infancy or childhood.

Most patients have a cyst or mass >5 cm. 

Nausea and vomiting is present in 70% of patients. 

Up to 20% of patients presents with fever.

emDOCs Podcast – Episode 67: Ovarian Torsion

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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