Welcome to the 174th FOAMed Quiz.
Question 1
The X-ray shown above belongs to your 13 year old patient in the Emergency Department after twisting the left knee while playing soccer. He is unable to bear weight.
Which of the following diagnoses is most likely?
A: Patella fracture with anterior cruciate ligament injury
B: Anterior tibial spine avulsion fracture with anterior cruciate ligament injury
C: Quadriceps tendon rupture
D: Displaced tibial plateau fracture with posterior cruciate ligament injury
E: Patellar tendon rupture with posterior cruciate ligament injury
The correct answer is B.
This case was covered on ALiEM this week.
The anterior tibial spine is the insertion point of the ACL. The injury is most common in pediatric patients. It can be caused by a twisting or pivoting knee injury, hyperextension or direct trauma.
SplintER Series: Don’t forget about the (tibial) spine!
Question 2
Your 23 year old patient presents with new onset anemia without clinical signs of blood loss. She is hemodynamically stable and did not receive any transfusions lately. Her MCV is 85 fL. Her liver and kidney function are normal. Thrombocytes and leukocytes are within normal range. Reticulocytes are 92/1000 cells (increased). LDH and bilirubin are elevated. Haptoglobin is decreased. Iron and ferritin are normal. The direct antiglobulin test (Coombs) is negative and the blood smear shows ‘’bite cells’’, but no other atypical cells. When asked she states her skin to have been ‘’a little bit yellow’’ once in a while for as long as she can remember.
Which of the following is the most likely cause of this patient’s anemia?
A: Hereditary spherocytosis
B: Vitamin B12 deficiency
C: Glucose-6-phostphate dehydrogenase deficiency (G6PD)
D: Auto-immune hemolysis
E: Sickle cell disease
The correct answer is C.
Acute hemolytic anemia was covered on EM@3AM last week.
The patient has new onset anemia, so sickle cell disease is very unlikely. High reticulocytes make a hemoglobin production problem such as vitamin B12 deficiency less likely. A normal MCV also does not fot vitamin B12 deficiency. A low haptoglobin points in the direction of hemolysis. The negative Coombs test makes auto-immune hemolysis unlikely and the absence of spherocytes on blood smear exclude hereditary spherocytosis. Bite cells are commonly identified in glucose-6-phosphate dehydrogenase deficiency. Her history of episodes of a yellow skin supports this diagnosis.
EM@3AM: Acute Hemolytic Anemia
Question 3
What is the proper location to apply a pelvic binder?
A: Over the iliac crest
B: Over the femur shaft
C: Over the greater trochanters
The correct answer is C.
Last week UMem covered pelvic binders.
This paper suggests that it takes about 8 attempts to properly apply a pelvic binder.
Question 4
The ECG above belongs to a patient with chest pain.
Which of the following waves is present?
A: N-wave
B: J-wave
C: U-wave
D: Epsilon-wave
The correct answer is A.
Dr. Smith’s ECG blog covered a case of N-wave NSTEMI last week.
N waves are transient appearing notches at the end of the QRS complex and are associated with myocardial ischemia. N-waves are usually ≥2 mm in size with respect to the PR segment which results in slight widening of the QRS complex. N-waves are usually seen in one or more of the inferior leads, and/or in leads I, aVL. An N-wave is also called a delayed activation wave of the left ventricular basal region. They indicate the LCx is likely to be the “culprit” artery.
Question 5
We universally advise patients to reduce screen time after a concussion, but so far evidence to support this habit lacks.
In this recently published paper, 663 children and adolescents with acute concussion and 334 children and adolescents with orthopedic injury were followed.
Postconcussion symptoms were measured (Health and Behavior Inventory) up to 6 months post injury. Screen time was measured by using the Healthy Lifestyle Behavior Questionnaire.
What did the authors find? Two answers are correct.
A: Low screen time was associated with relatively more severe symptoms in the concussion group compared to the orthopedic injury group during the first 30 days post injury
B: Intermediate screen time was associated with relatively more severe symptoms in the concussion group compared to the orthopedic injury group during the first 30 days post injury
C: High screen time was associated with relatively more severe symptoms in the concussion group compared to the orthopedic injury group during the first 30 days post injury
The correct answers are A and C.
The paper was covered on DFTB last week.
Interestingly, low and high screen time were both associated with relatively more severe symptoms in the concussion group compared to the orthopedic injury group during the first 30 days post injury but not after 30 days.
The 67th Bubble Wrap
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
