2019. QUIZ 18. WEEK 03

Question 1

According to this recently published paper, does midazolam 0.05 mg/kg pre-medication prevent recovery agitation in adults undergoing procedural sedation with ketamine?

A: Yes, and it even shortened recovery time

B: Yes, but it delayed recovery time

C: No, but it shortened recovery time

D: No, and it delayed recovery time

The correct answer is B

Midazolam seems to prevent recovery agitation in adults, but in this study it delayed recovery time. The overall level of agitation as defined in the study was just under 64% in the placebo group vs 25% for midazolam and 20% for haloperidol. Yes, they compared haloperidol to placebo as well and it too seems to prevent recovery agitation, but is lengthened the recovery time even more.

JC: Should we premedicate for ketamine sedation? St Emlyn’s

Question 2


Which statement is NOT true about lead intoxication?

A: Children absorb lead more effectively that adults

B: A smaller particle size means faster absorption

C: A lead foreign body cannot be excluded using conventional X-rays

D: Checking lead levels can be useful in lead ingestion

The correct answer is C

If you don’t see a lead foreign body on your X-ray, it’s not there.
As you can image, a smaller particle size does lead to faster absorption and children absorb lead more effectively than adults. Indeed, Checking lead levels can be useful in lead ingestion.

Ingested Lead Foreign Bodies: Not a Typical FB

Question 3


You find yourself on a perfect white beach in Mexico. Having a beer, enjoying the sun. Until, when taking a swim in the turquoise sea, you feel a sharp pain in your right leg. After removing some jellyfish tentacles, which treatment provides the most adequate pain relief?

A: Urine

B: Vinegar

C: Hot water

D: Beer

The correct answer is C

While vinegar might prevent discharge of nematocysts in some species, it is not as effective as immersion of the limb in hot water (as hot as you can tolerate). Please use a thermometer if (local) anesthetics are used for some reason.

Beer might provide some pain relief when the dosage is adequate.

Urine.. Well urine is useless. However, it is always fun to tell your friends otherwise.

Tox and Hound – Some Like It Hot

Question 4

Which statement is NOT true about pneumomediastinum?

A: It is most often life threatening

B: Infection with gas-forming organisms can cause pneumomediastinum

C: Esophageal perforation can lead to pneumomediastinum

D: The heart exam may reveal a characteristic crunching sound

The correct answer is A

Pneumomediastinum can be benign. However, this depends on the etiology. It is true that infection with gas-forming organisms can cause pneumomediastinum. This is associated with mediastinitis. The crunching sound synchronous with systole is called Hamman’s sign.

SinaiEM covers pneumomediastinum this week.

Question 5

Which statement is true regarding acute Right Coronary Artery (RCA) occlusions.

A: 50% of inferior STEMI is caused by RCA occlusion

B: Proximal RCA occlusions always result in ECG or hemodynamic deterioration

C: When there is ST depression in lead V2 and a proximal RCA occlusion, there is STE in V1 most of the time

D: Diagnosis of right ventricular myocardial infarction is not important in the presence of hemodynamic instability

The correct answer is C

This recent post on Dr. Smith’s ECG blog is all about right ventricular myocardial infarction. It seems 85% of inferior STEMI is caused by RCA occlusion. RCA occlusions lead to hemodynamic instability in a minority of cases. However, in the presence of hemodynamic instability diagnosis of right ventricular myocardial infarction is very useful.

This recent dr. Smith’s ECG blog is all about right ventricular myocardial infarction.

Thank you for joining us. Hope to see you next week!

Eefje and Rick, the FOAMed Quiz crew

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