Quiz 173, December 30th, 2022

Welcome to the 173th FOAMed Quiz.

A short one this time!

Happy new year!

Question 1

Source image: www.radiopaedia.org

A 37-year old male presents with pain in his left foot after stepping into a pothole. You obtain radiographs and find a small bony fragment between the base of the 1st and 2nd metatarsal, which is associated with Lisfranc injury.

This small bony fragment between the base of the 1st and 2nd metatarsal has a name. How is it called?

A: Cupid’s bow sign

B: Inverted Napoleon Hat Sign

C: Sail Sign

D: Fleck sign

The correct answer is D.

Lisfranc injury was covered on SinaiEM last week.

Cupid’s bow sign is seen as a normal variant in the endplate of the vertebral body.

Inverted Napoleon Hat Sign is a radiologic sign seen on the frontal pelvic or lumbar radiograph at the level of the 5th lumbar vertebra and the sacrum.

Sail sign is also known as the anterior fat pad sign, describing the elevation of the anterior fat pad to create a silhouette similar to a billowing spinnaker sail from a boat.

Fleck sign is an avulsion fracture of the second metatarsal or medial cuneiform and associated with a Lisfranc injury.

Lisfranc Injury

Question 2

Source image: www.medindia.net

You are treating your patient for severe methemoglobinemia.

Which of the following is first line treatment?

A: Ascorbic acid

B: Methylene blue

C: Exchange transfusion

D: Hyperbaric oxygen

The correct answer is B.

Methemoglobinemia was discussed in this week’s emDOCS ToxCard.

Methylene blue is a carrier for electrons which aids in reducing Fe3+ back to Fe2+ and thus resolving methemoglobinemia. Ascorbic acid is also an option, but it acts a lot slower.

Treatment with exchange transfusion and hyperbaric oxygen have been described in case reports.

ToxCard: Methylene Blue

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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