Frostbite Board Review Questions, Free Cold Injury CME Quiz
This week's Med-Challenger free CME quiz - Frostbite - the quick quiz covers the classification of frostbite, the terminology associated with cold-induced injuries, the physiologic processes that lead to tissue loss from frostbite, and the ideal temperature range of water for rewarming frostbitten extremities.
A free sample Frostbite question included below. The full Frostbite CME quiz is free online for a limited time. You can earn AMA CME credit - and now you can earn ANCC contact hours as well! Play now.
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Here's this week's sample CME board review question on frostbite:
A 29-year-old man presents with localized pain and paresthesia to his fingertips after exposure to cold weather.
Paresthesia resolves within minutes with rewarming.
What is this patient's diagnosis?
See the Answer:
The correct answer is:
Explain the terminology associated with cold-induced injuries.
Frostnip refers to a cold-induced, localized area accompanied by both pain and paresthesia. Frostnip is rapidly reversible with rewarming and does not result in tissue damage.
This patient has frostnip, which is associated with significant vasoconstriction and is accompanied by discomfort in the involved parts (see Figure 1). If it is left unattended, frostnip can eventually progress to frostbite.
Figure 1 - Frostnip
Pernio, also referred to as chilblain, is characterized by localized inflammatory lesions from acute or repetitive exposure to damp cold temperatures above freezing.
Chilblains are thought to be due to cold-damaged microvessels that leak and cause inflammation, leading to small, red swellings that are usually painful, itchy, and tender to touch. In severe cases, the surface of the skin may break and sores or blisters can develop. The inflammation characteristic of chilblain is similar (albeit much less severe) to that found when frostbitten extremities are thawed (see Figure 2).
Figure 2 - Local inflammation due to chilblain.
Frostbite is a localized, cold-induced ischemic injury that results in temporary or permanent tissue damage (depending on the depth of frostbite). In contrast to frostnip and chilblain, frostbitten tissues become pain free, which makes a person lose awareness and, therefore, protective behavioral reflexes.
Freer L, et al. Frostbite (chapter 9). In: Auerbach PS, et al. Auerbach's Wilderness Medicine. 7th ed., 2017:197-222.
Zafren K. Danzl DF. Frostbite and nonfreezing cold injuries (chapter 131). In: Walls R, et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed., 2018:1735-1742.
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