2018. QUIZ 8. WEEK 45

Question 1

Your 2 year old patient just had a simple febrile seizure. The child does fine now and you explain to the parents that there is a 1/3th chance of recurrence. No medication can prevent this. Then your savvy resident points out a recent Japanese paper by Murata et al. What did this study show?

A: Regular administration of Acetaminophen per rectum decreased the recurrence rate of a febrile seizure compared to no treatment during the same febrile episode

B: Regular administration of Acetaminophen per rectum did not have any impact on recurrence rate of a febrile seizure in the same febrile episode

C: Regular administration of Acetaminophen per rectum increased recurrence rate of a febrile seizure in the same febrile episode

The correct answer is A

There might be some hope after all.. In this study comparing Acetaminophen per rectum to no treatment there was an impressive reduction in recurrence rates of febrile seizures (9.1 vs 25.3 percent) during the same febrile episode.

Don’t forget the Bubbles discusses this paper in detail.

And do read the full paper here.

Question 2

Which statement is true about the rash typically found in Scarlet Fever?

A: It is a “wet” rash

B: It is worse in skin folds

C: Skin peeling on the fingers is uncommon

The correct answer is B

The rash in Scarlet fever is typically dry (sandpaper rash). It is worse in skin folds and skin peeling on the fingertips occurs often after resolution of symptoms.

The RCEM learning podcast talks about Scarlet fever in the November podcast.

Don’t forget the Bubbles posted about Scarlet fever recently as well.

Question 3

Methanol poisoning can be fatal. Current treatment regimens include ethanol (if Fomepizole is not available). So why does it help to get someone even more drunk to prevent blindness, loss of consciousness and eventually death in methanol poisoning?

A: By inhibiting the enzyme alcohol dehydrogenase

B: By accelerating excretion through the kidneys

C: By making the patient so drunk she of he will be unable to drink more bad liquor

The correct answer is A

Methanol is metabolized to formaldehyde by alcohol dehydrogenase. Formaldehyde on its turn is metabolized to formic acid and is anion formate. Formate is the bad guy. By preventing (slowing down) metabolization of methanol, less toxic formate is produced.

Further treatment includes bicarbonate, dialysis and folinic acid (the latter to help break down formic acid into carbon dioxide and water).

EMdocs published an overview of methanol poisoning recently.

Question 4

The American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) published a Clinical Policy in which recommendations are given regarding risk stratification scores, 3-hour troponin rule out strategy and diagnostic testing after ruling out Myocardial Infarction in the Emergency Department.

What is the missed diagnosis rate for Major Cardiac Adverse Events (MACE) at 30 days the committee assumed to be acceptable for providers and patients?

A: 1% missed diagnosis rate

B: 1-1,5% missed diagnosis rate

C: 1-2% missed diagnosis rate

The correct answer is C

The committee acknowledges the imperfections in diagnostic testing and our inability to reduce a missed diagnosis rate to lower than 1%, despite extensive use of diagnostic testing (CT coronary, stress tests etc.).

Emergency Medicine Literature of Note discusses and applauds this recently published Clinical Policy by the ACEP.

You can find the publication here. It is a good read!

Question 5

The 2017 PROCAMIO trial compared the effectiveness and adverse events of amiodarone versus procainamide intravenously for the treatment of stable ventricular tachycardia. The study showed:

A: More Major Adverse Cardiovascular Events after 40 minutes in the procainamide group

B: Procainamide terminated the tachycardia in 67 percent of the patients, versus 38 percent in the amiodarone group

C: Hypotension requiring cessation of the infusion was the most common side effect more frequently reported in patients treated with amiodarone

Correct answer is B.

Procainamide terminated more stable ventricular tachycardias than Amiodarone (67 versus 38 percent).

Furthermore, Amiodarone led to more Major Adverse Cardiovascular Events (41 vs 9 percent). Hypotension requiring immediate electric cardioversion was the most common side effect in both groups.

Hypotension requiring cessation of the infusion was reported for 1 patient in each group.

Rebel EM reviewed this paper when it was published and recently SinaiEM discussed the paper one more time.

Thanks for joining us again! See you next week!

Eefje and Rick (The FOAMed Quiz Crew)