Quiz 135, November 26th, 2021

Welcome to the 135th FOAMed Quiz.

 

Only 3 questions this week.. Enjoy!

 

Source image: www.pixabay.com

Question 1

Diabetic Ketoacidosis (DKA) is a life threatening event in which fluid replacement is important. Current guidelines recommend normal saline. However, normal saline can cause hyperchloremic acidosis and might worsen the DKA. An alternative could be Plasmalyte, which as a side effect may increase ketone bodies. A true consensus has not been reached.

In this trial, 90 patients with DKA were randomised to either Plasmalyte or normal saline.

What did the authors find?

A: Patients in the Plasmalyte group had slower resolution of DKA and an increased ketosis

B: Patients in the Plasmalyte group had faster resolution of DKA, but an increased ketosis

C: Patients in the Plasmalyte group had slower resolution of DKA, but not an increased ketosis

D: Patients in the Plasmalyte group had faster resolution of DKA, and not an increased ketosis

The correct answer is D

This week Mark Ramzy discussed this study on RebelEM.

The authors conclusion was that Plasmalyte-148, compared to Sodium chloride 0.9%, may lead to faster resolution of acidosis in patients with a DKA without an increase in ketosis. A larger Phase 3 trial is needed for further conclusions.

SCOPE-DKA: Normal Saline vs Plasmalyte in Severe DKA

Source image: www.pixabay.com

Question 2

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a potentially fatal drug reaction. Fortunately it is very rare.

Which of the following drugs are most commonly associated with DRESS?

A: NSAIDS

B: Antidepressants

C: Antiepileptics

D: Antibiotics

The correct answer is C.

DRESS was covered on PedEM Morsels this week.

Antiepileptics are the drugs commonly associated with DRESS.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

 

Case courtesy of Dr Eric F Greif, Radiopaedia.org, rID: 29674

Question 3

Atraumatic back pain is a pretty common complaint in ED. Cauda Equina Syndrome is one of the diagnoses requiring fast intervention. Unfortunately, classic symptoms are often not strong predictors.

The authors of this recently published retrospective review evaluated which symptoms and clinical findings in patients with atraumatic back pain correlate best with the diagnosis of cauda equina compression (CEC).

Which of the following symptoms appeared to be most suggestive for CEC?

A: Bilateral leg pain

B: Dermatomal sensory loss

C: Bilateral absent ankle or ankle and knee jerks

D: Lower anal sphincter tone

The correct answer is C.

This week JournalFeed discussed this article about Cauda Equina Compression.

Bilateral absent ankle or ankle and knee reflexes was the strongest predictor of CEC (OR=2.9), followed by bilateral leg pain (OR=2.2) and dermatomal sensory loss (OR 1.8). The authors did not find a relationship between digital rectal examination findings and the diagnosis of CEC.

Keep in mind this was a single-centre study and that the individual diagnostic performance of all history or exam elements was poor.

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This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Gijs de Zeeuw, Nicole van Groningen and Joep Hermans

Reviewed and edited by Rick Thissen