2018. QUIZ 1 WEEK 38

Question 1

What is the mainstay of diagnostic imaging in cecal volvulus in children?

A: Abdominal ultrasound

B: Plain abdominal X-ray

C: Contrast enema

The correct answer is: C

Contrast enema is the mainstay in diagnosing cecal volvulus in children although abnormalities can be seen on color doppler abdominal ultrasound. In abdominal X-ray abnormalities can be seen as well including signs of small bowel obstruction and dilated cecum or colon.

Pediatric EM Morsels gives a nice overview of this rather rare condition in children.

 

Question 2

Which statement is correct regarding the risk of thrombosis in patients with a mechanical heart valve?

A: The annual risk of thrombosis and systemic embolization of a mechanical mitral valve is approximately 40 percent

B: Mitral valves carry a higher risk than aortic valve due to lower flow on the atrial side of the mitral valve

C : If a patient has dual mechanical valves, the risk is not increased compared to the risk in patient with only one mechanical valve

D: Newer bileaflet design valves carry a higher thrombotic risk than older designs (tilting-disk or ball & cage design)

Answer B is correct

The annual risk of thrombosis and systemic embolization of a mechanical mitral valve is approximately  12-15 percent

If a patient has dual mechanical valves, the risk is cumulative and therefore there is an overall higher risk

Newer bileaflet design valves carry a lower thrombotic risk than older designs (tilting-disk or ball & cage design)

This excellent post on mechanical valves and intracranial hemorrhage appeared on CanadiEM

Question 3

Which Ventricular Tachycardia has a better prognosis, Classic VT or Idiopathic VT?

”’Idiopathic VTs as a group are more commonly seen in younger, healthier patients than the typical classic VT patient, and are generally considered to have excellent prognosis with low rates of hemodynamic compromise and rhythm deterioration.””

Pendell Meyers gives a great overview of Idiopathic Ventricular Tachycardias

 

Question 4

According to the SMART trial, released in February 2018. Is there a statistically significant difference in the primary outcome (composite of death, new renal-replacement therapy, and persistent renal dysfunction) between a group of ICU-patients treated with Normal Saline and a group of ICU-patients treated with a balanced solution?

A: Yes, there was a statistically significant difference in primary outcome

B: Well, maybe. The paper reports a statistically significant difference in primary outcome. But the calculations may be flawed

C: No, there where no differences between the two groups

Answer B is correct

First 10 EM discusses this paper one more time in their series about IV fluid choice, questioning the calculations and the reported p-value.

The Bottom line and RebelEM discussed this paper in detail 6 months ago.

But ofcourse, have a look yourself!

Question 5

Are we (Emergency Physicians) any good in predicting hospital admission at the time of triage?

A: No, we are basically worthless when it comes to this

B: Well, we are fairly good, but not to an extend that it is clinically helpful

C: Yes, we are really, really good at this

The correct answer is A: we are worthless when it comes to this

The Resus Room Podcast takes you in their latest papers of the month through a paper by Vlodaver et al. published this year, that shows a sensitivity for predicting hospital admission at triage of 51,8 percent. 

Well, that’s all for now. I hope to see you next week!

Rick

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