Quiz 175, January 13th, 2022

Welcome to the 175th FOAMed Quiz.


Question 1

Source image: www.sinaiem.org

Which of the following radiographic views is most appropriate for assessment of symmetry in the ankle joint?

A: AP view

B: Mortise view

C: Lateral view

The correct answer is B.

SinaiEM covered radiography of the ankle last week.

The standard ankle radiographic series consists of the AP, mortise and lateral views. The image is obtained in internal rotation at 15-20 degrees with the foot in slight dorsiflexion. The joint space width should be uniform and should measure about 4 mm.

The Ankle Radiograph

Question 2

Source image: www.medicosisperfectionalis.com

In acid base disturbances, most of us are taught to use the Henderson–Hasselbalch equation (pH = pKₐ + log([A⁻]/[HA])). Although this simplistic approach is sufficient for use in the ED most of the time, it is notoriously imperfect and incomplete.

Another method of analyzing acid-base disturbances uses electroneutrality as a main principle. Anions and cations have to be balanced to maintain electroneutrality. Addition of anions (like chloride) means less other anions (like bicarbonate) are present. Addition of cations (like sodium) means more anions can be present. So, a higher concentration of anions causes acidosis and a higher concentration of cations causes alkalosis.

What is the name of this approach to acid-base disturbances?

A: Liebermeister’s rule

B: Naegele’s rule

C: Coons method

D: Stewart method

The correct answer is D.

DFTB covered acid-base disturbances and fluid therapy last week.

The approach described above is known as the Stewart method.

Coons fluorescent antibody method is about detection of antibodies by fluorescence microscopy using fluorescein-labeled antibodies.

Liebermeister’s rule says for each fever degree Celsius the cardiac frequency increases 8 beats per minute.

Naegele’s rule is a method of estimating the due date.

Time for a fluid shift?

Question 3

Source image: https://en.rotterdam.info/

Your 40 year old patient who works in a fireworks factory presents with yellowish, necrotic, full‐thickness burns on his hands. You suspect white phosphorus exposure and you start copious irrigation and removal of visible particles.

What is the safest method to make the white phosphorus particles more visible?

A: Add copper sulfate tot the wound

B: Use a Woods lamp

C: Nothing, the particles are so small, you can’t visualize them anyway

The correct answer is B.

Taming the SRU covered caustic skin injuries last week.

White phosphorus burns can be very severe and even life threatening. It auto-combusts at about 30 degrees Celsius, leading to thermal burns and it causes extensive chemical burns due to it’s lipophilic properties. The wound should be irrigated extensively and visible particles should be removed. Copper sulfate turns white phosphorus black, making it more visible. However, copper sulfate can lead to systemic toxicity (hemolysis) and is no longer used for this purpose. A Woods lamp can be used instead to visualize the particles.

Question 4

Source image: www.aliem.com

The photo shown above belongs to your 54 year old patient in the Emergency Department. He has a medical past of atrial flutter and alcohol abuse. This wound is already six months present and there is no history of prior infection, trauma or surgery. The wound is intermittent and mildly painful. He has no other complaints.

Which of the following diagnoses is most likely?

A: Sister Mary Joseph (SMJ) nodule

B: Brother Mary Joseph (BMJ) nodule

C: Umbilical Joseph Infection (UJI) nodule

D: Umbilical Mid Laceration (UML) nodule

The correct answer is A.

This case was covered on ALiEM this week.

A Sister Mary Joseph nodule is a rare cutaneous metastasis of gastrointestinal or genitourinary primary malignancies to the umbilicus. Sister Mary Joseph nodules arise late in disease and portend a poor prognosis. The mean survival of patients with SMJ nodules is less than 12 months.

SAEM Clinical Images Series: An Ominous Umbilical Lesion

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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