Quiz 58, January 17th, 2020

Welcome to the 58th FOAMed Quiz. 

Enjoy!

Kirsten, Eefje, Hüsna, Joep and Rick

Question 1

Source image: https://www.aliem.com. Case courtesy of Andrew Murphy, Radiopaedia.org

Which of the following suspected injuries of the hand and wrist can be a reason to perform a ‘’clenched fist view’’?

A: A hook of hamate fracture

B: Scapholunate dissociation

C: A Scaphoid Fracture

D: Perilunate or lunate dislocation

The correct answer is B

AliEM covered radiographic approach to the injured wrist this week.

A hook of hamate fracture can be seen most easily on a carpal tunnel view. 

A perilunate or lunate dissociation should be visible on normal AP and Lateral views. 

Scaphoid series might help you find a scaphoid fracture, which leaves a Scapholunate dissociation to be most easily found on a ‘’clenched fist view’’.

EMRad: Radiologic Approach to the Traumatic Wrist

Question 2

Source image: www.pixabay.com

An otherwise healthy 24-year-old female is brought to the emergency department by her roommate because of an altered mental status. They went to a party together. After she got home this morning she was acting strange and progressively became more somnolent. The roommate admits she and the patient taking 3,4-Methylenedioxymethamphetamine (MDMA) last night. Her sodium comes back 103 mEq/l.

Which of the following statements is true regarding the hyponatremia in this patient?

A: MDMA causes hyponatremia due to adrenal insufficiency and polydipsia

B: MDMA causes hyponatremia due to heart failure and polydipsia

C: MDMA causes hyponatremia due to hypothyroidism and polydipsia

D: MDMA causes hyponatremia due to Syndrome of Inappropriate ADH secretion (SIADH) and polydipsia

The correct answer is D

EmDocs covered the pearls and pitfalls of hyponatremia this week.

This patient most likely suffered acute hyponatremia after using MDMA at the party. Drugs like MDMA can be a trigger for SIADH.

Patients with acute onset hyponatremia are at risk for cerebral edema because intracellular osmolality suddenly exceeds extracellular osmolality. This causes water to move into the cells.

Current recommendations have defined correction should be no greater than 8 mEq/L in a 24-hour period and a total of 16 mE1/L in a 48-hour period.

 

Critical Hyponatremia: Pearls and Pitfalls

Question 3

Source image: www.pixabay.com

Febrile illnesses are the most common cause of presentation to acute pediatric medical services. Which of the following statements is true about fever in children?

A: Bacteria are killed more easily by antibiotics at higher core temperatures

B: Higher temperature indicates a more serious infection

C: Rigors are associated with an increased risk of bacterial infection in children

D: Fever should always be treated with antipyretics

The correct answer is A.

Don’t forget the bubbles covered fever last week. 

Fever is a beneficial response to an infection, with higher temperatures promoting the immune response and inhibiting the growth of pathogens. Furthermore, bacteria are killed more easily by antibiotics at higher temperatures.

There is little to no evidence that higher temperatures, fever that don’t respond to antipyretics, or rigors indicate an increased risk of a serious infection.

Since fever doesn’t cause any harm (unless exceeding 41°C (105.8°F), treating a fever is only necessary if the child is uncomfortable.

Hot Garbage: Mythbusting fever in children

Question 4

This French retrospective, observational, multicenter study is about efficiency of thrombolysis in out of hospital cardiac arrest (OHCA) caused by pulmonary embolism (PE). The primary endpoint was 30-day survival. 328 patients with confirmed or suspected PE were included. What did the authors find?

A: Thirty-day survival was higher in the thrombolysis group than in the control group but good neurologic outcome was not significantly different

B: Thirty-day survival was higher in the thrombolysis group than in the control group and good neurologic outcome was significantly higher in patients receiving thrombolysis

C: Thirty-day survival was similar in the thrombolysis group and the control group and good neurologic outcome was not significantly different

D: Thirty-day survival was similar in the thrombolysis group but good neurologic outcome was significantly higher in patients receiving thrombolysis

The correct answer is A

Clay Smith covered this paper on JournalFeed last week.

The authors of the paper state: ‘‘Thirty-day survival was higher in the thrombolysis group than in the control group (16% vs 6%; P ¼ .005) but the good neurologic outcome was not significantly different (10% vs 5%; adjusted relative risk, 1.97; 95% CI, 0.70-5.56).’’

However, it is a bit unclear to me which patient were eventually considered having PE. ‘’PE was diagnosed on hospital admission by CT pulmonary angiography (CTPA) (definite PE) or echocardiogram (probable PE)’’. There is no mention of sonographic evaluation for deep venous thrombosis.

Question 5

Which of the following statements is true about the Greater Occipital Nerve Block (GONB)?

A: If palpation of the Greater Occipital Nerve (GON) reproduces headache pain or irritation, it should be avoided

B: The GONB can be used in the treatment of refractory migraine, cluster headache, occipital neuralgia, or cervicogenic headache

C: A GONB should not be performed bilaterally

D: The GON lies just lateral to the occipital artery

The correct answer is B

NUEM covered the GONB this week.

GONB has been used in the treatment of cervicogenic headache, cluster headache, and occipital neuralgia, with demonstrated efficacy in improving pain and reducing headache frequency.

If palpation of the GON reproduces headache pain or irritation, it may be a good target for GONB

A GONB can be performed bilaterally if needed and the GON lies just medial to the occipital artery.

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This quiz was written by Eefje Verschuuren, Kirsten van der Zwet, Hüsna Sahin and Joep Hermans

Reviewed and edited by Rick Thissen

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