Quiz 78, July 31th, 2020

Welcome to the 78th FOAMed Quiz. 


Eefje, Nicole, Joep and Rick

Question 1

Tricuspid Annular Plane Systolic Excursion (TAPSE) is a quantitative measurement of the movement of the tricuspid annulus during the cardiac cycle and is quite often measured as a surrogate of right ventricular function.

Which of the following statements is true about TAPSE?

A: TAPSE is a multiple-plane measurement

B: TAPSE is very sensitive for pulmonary embolism in normotensive patients

C: Abnormal TAPSE measurement is only seen in pulmonary embolism

D: A TAPSE of less than 2 cm is considered abnormal

The correct answer is D

County EM covered TAPSE as a diagnostic parameter for pulmonary embolism this week.

TAPSE is a pretty easy one plane measurement in apical view.

Right ventricle dysfunction may still be present with normal TAPSE.

TAPSE is not sensitive or specific enough in normotensive patients, however it is more sensitive in patients with tachycardia.

Abnormal TAPSE measurement may be seen in other disease processes that cause RV strain, such as pulmonary hypertension, RV ischaemia, and congestive heart failure.

A TAPSE of less than 2 cm is considered abnormal.

Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 31240

 Question 2

Your 78 year old patient presents to the ED after a fall with her bicycle. She turns out to have 3 rib fractures. According to this paper  which of the following parameters is a useful predictor for length of stay (LOS) in the hospital?

A: Change in pain between day one and two

B: FEV1 on day one

C: Grip strength on day one

The correct answer is B

Sam Parnell covered this paper on JournalFeed.

It turns out FEV1 is a reliable predictor of LOS. The course of pain is not. Furthermore, pain did not correlate with spirometry values.

Spirometry as a adjunct test to decide which patients can be discharged sure sound interesting.


Source image: www.pixabay.com

Question 3

You see a forty year old male patient with gastritis. You consider prescribing a combination of an antacid and lidocaine.

What is the benefit of this cocktail compared to antacid monotherapy?

A: Faster pain relief

B: Better pain relief

C: Less adverse events

D: There is no benefit

The correct answer is D

This recently published randomised controlled trial compared antacid monotherapy versus antacid and lidocaine.

The authors included and randomised 89 patients. They found no statistical difference in pain scores between the groups. Patients did prefer the taste of the antacid monotherapy and there were more adverse events reported in the lidocaine group.

Don’t use lidocaine for epigastric pain

Question 4

Progressive weakness of extremities and diminished reflexes in the affected limbs are cornerstone features of Guillain-Barre Syndrome (GBS).

Which of the following features is inconsistent with GBS?

A: Relatively symmetric symptoms

B: Fever at onset of symptoms

C: Cranial nerve involvement

D: Autonomic dysfunction

The correct answer is B

Josh Farkas covered GBS on the internet book of critical care this week.

The usual presentation of this disease involves sensory disturbances, ascending flaccid paralysis and autonomic dysfunction. Cranial nerve involvement can be present, especially facial palsy. Although infection is involved as a trigger, fever is not typically present at onset of the disease.

Guillain Barre Syndrome (GBS)

Question 5

Source image: Pixabay.com

The prognosis of traumatic cardiac arrest is dismal. Which of the following parameters is associated with higher odds of survival according to this paper?

A: Bystander CPR

B: Prehospital intubation

C: Penetrating mechanism of injury

D: Use of prehospital or in-hospital epinephrine 

The correct answer is A

RebelEM covered this systematic review and meta-analysis on prognostic factors in traumatic cardiac arrest last week. 

A total of 53 studies involving 37,528 patients were included.

Male sex, penetrating mechanism of injury and head injury were not associated with a lower or higher survival rate. 

Presence of cardiac motion on ultrasound, shockable initial cardiac rhythm, witnessed arrest and bystander CPR had higher odds of survival. 

Use of prehospital or in-hospital epinephrine and prehospital intubation had lower odds of survival.

Traumatic Cardiac Arrest – Can we Find Prognostic Factors that Predict Survival?

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This quiz was written by Eefje Verschuuren, Nicole van Groningen and Joep Hermans

Reviewed and edited by Rick Thissen