qSOFA, Measles, GBS and more...
Question 1
In a recently published paper by Usman, which tool turned out to be the most accurate when applied as a screening tool for severe sepsis or septic shock?
A: SIRS
B: qSOFA
C: NEWS
The correct answer is C
NEWS came out a little better than SIRS and definitely better than qSOFA. Yes, this is a single center, retrospective study, but the results sound promising. NEWS is simple to use and does not need any laboratory testing. It was not developed as a screening tool in the ED but neither was pSOFA and that one made it in the Sepsis-3 definitions.
R.E.B.E.L. EM discusses the Usman paper in detail.
http://rebelem.com/early-sepsis-screening-in-the-emergency-department/
Question 2
Which statement is true about diagnosis and management of pulmonary embolism?
A: Elevated BNP is not associated with worse prognosis
B: Elevated Troponin Levels are not associated with worse prognosis
C: ECG findings are highly sensitive and specific
D: rt-PA 50mg over 2 hours has shown similar efficacy to 100mg over 2 hours in clinical outcomes with a better safety profile (less bleeding) in massive PE
The correct answer is D
Yes, we are probably still administering too high doses of thrombolytics in massive and sub-massive PE. Elevated BNP and troponin levels are associated with worse prognosis. ECG findings (including sinus tachycardia, S1Q3T3 pattern, precordial T wave inversions (V1 – V4) and new (complete or incomplete) right bundle branch block) have very low diagnostic value.
This re-post of an R.E.B.E.L. EM overview on pulmonary embolism appeared recently on emDOCs
R.E.B.E.L. EM – The Critical Pulmonary Embolism Patient
Question 3
Which of the following is not a symptom of Adrenal Insufficiency?
A: Hyponatremia
B: Eosinophilia
C: Hyperkalemia
D: Neutrophilia
The correct answer is D
Well, hyponatremia and hyperkalemia speak for themselves. It seems Adrenal insufficiency also leads to Eosinophilia by decreased suppression. We would expect a relative neutropenia in a patient with adrenal insufficiency, not neutrophilia.
This week’s chapter of the Internet Book of Critical Care is about Adrenal Crisis.
IBCC chapter & cast- Adrenal crisis
Question 4
Which statement is true about Measles?
A: The virus stays alive outside the human body for about 2 minutes
B: The transmission rate in an unvaccinated household is about 50%
C: Encephalitis occurs in about 1 in 1.000 patients
D: A patient is only contagious when the rash is present
The correct answer is C
Much feared Measles encephalitis occurs in about 1 in 1000 patient with Measles. The virus stays alive quite long (for 2 hours) outside the body and this is part of the reason it has such a high transmission rate (90% in an unvaccinated household). Patients are contagious about 4 days before and 4 days after the rash is present. Other symptoms (like coryza, conjunctivitis, cough, Koplik spots and fever) start up to 3 days before the rash appears. Treatment consists of supportive care.
Question 5
Which bacteria does not belong to the group we are most afraid of in a sick neonate?
A: Group B Streptococci
B: Listeria monocytogenes
C: Bifidobacterium infantis
D: Escherichia coli
The correct answer is C
Group B Streptococci, Listeria monocytogenes and Escherichia coli make the group of bacteria we are very afraid of in the sick neonate. Bifidobacteriae are part is the normal intestinal flora of infants.
Pediatric EM Morsels most recent blog is about Group B Streptococcus infection in the neonate.
Group B Strep (GBS): Early, Late, and Very Late
Thanks for joining us again! Good luck with Christmas shopping and hope to see you next week..
Remember.. If you have any suggestions please comment or send us an e-mail (rick@thefoamedquiz.org).
Eefje and Rick, the FOAMed Quiz Crew