Quiz 172, December 23rd, 2022

Welcome to the 172th FOAMed Quiz!


Question 1

Source image: www.radiopaedia.org

In hip dislocations of native joints (no total hip arthroplasty), which of the following is the most common?

A: Postero superior dislocation

B: Postero inferior dislocation

C: Antero superior dislocation

D: Antero inferior dislocation

The correct answer is A.

Hip dislocation was covered on AliEM last week.

Posterosuperior hip dislocations are the most common type of dislocation in native joints as well as total hip arthroplasties.

SplintER Series: Hip, Hip, Hooray!

Question 2

Source image: www.wikipedia.org

You work in a remote, resource-poor location in Southeast Asia and your 24 year old patient comes in with fever, aggressive behavior and hydrophobia. You suspect rabies.

What are the chances of survival in this patient?

A: Negligible

B: 5 percent

C: 10 percent

D: 20 percent

The correct answer is A.

Rabies is caused by a neurotropic lyssavirus and is transmitted via saliva of infected animals.
The chance of survival once symptoms appear are negligible.

EM@3AM: Rabies

Question 3

Source image: www.mountnittany.org

A bite by which of the following animals is the most common cause of rabies in the previously (question 2) described patient?

A: Rabbit

B: Reindeer

C: Dog

D: Bat

The correct answer is C.

In resource-poor countries, rabid dogs account for 90 percent or more of reported cases of rabies transmitted to humans. Reindeer actually can carry rabies. It cannot be carried by reptiles, amphibians, rabbits, or insects.

EM@3AM: Rabies

Question 4

Source image: www.castoredc.com

Okay, bonus question on rabies. A very controversial and aggressive treatment protocol that includes therapeutic coma, ketamine infusion and amantadine was developed in 2004. Experts advise against the use of this treatment combination due to lack of supportive evidence.

What is the name of this protocol?

A: Madison protocol

B: Chicago protocol

C: Minneapolis protocol

D: Milwaukee protocol

The correct answer is D.

Rabies was covered on EM@3AM last week.

The Milwaukee protocol was used to treat a 15 year old girl in 2004. The girl survived. However, the effectiveness of this protocol remains very poor in subsequent studies.

EM@3AM: Rabies

Question 5

Source image: www.aliem.com

Your 15 year old patient presents with osteomyelitis of the frontal bone associated with a subperiosteal abscess.

What is this disease called?

A: Brodie abscess

B: Evans tumor

C: Kaposi sarcoma

D: Pott’s puffy tumor

The correct answer is D.

Pott’s puffy tumor was covered on AliEM last week.

A Brodie Abscess is a subacute or chronic pyogenic osteomyelitis.

An Evans Tumor is a low-grade fibromyxoid sarcoma.

Kaposi sarcoma is a low grade vascular tumor associated with human herpesvirus 8 infection.

Pott’s puffy tumor indeed is osteomyelitis of the frontal bone associated with a subperiosteal abscess.

SAEM Clinical Images Series: Facial Swelling

Question 6

Source image: captionsfunnynl.blogspot.com

Fitz-Hugh Curtis Syndrome (FHCS), also known as perihepatitis is characterized by inflammation of the liver capsule and surrounding peritoneum with “violin-string” adhesion formation.

Which of the following patients is most likely to contract FHCS?

A: A 20 year old male

B: A 60 year old male

C: A 20 year old female

D: A 60 year old female

The correct answer is C

FHCS was covered on ACEP Now last week.

FHCS is a rare complication of pelvic inflammatory disease (PID). It’s usually found in sexually active women, but there are also reports of FHCS occurring in men. The most common causative organisms are Chlamydia trachomatis and Neisseria gonorrhoeae.

Case Report: Fitz-Hugh Curtis Syndrome in a Male with HIV

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This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Nicole van Groningen, Jeroen van Brakel, Noortje Geerts and Renée Deckers

Reviewed and edited by Rick Thissen