Welcome to the 136th FOAMed Quiz.
Question 1
The addition of vasopressin and methylprednisolone to standard care in cardiac arrest has shown promising in this 2009 and this 2013 papers.
Last month, the VAM-IHCA trial was published. 501 patients with in hospital cardiac arrest (IHCA) were randomised after the first dose of adrenaline to either standard care and standard care plus vasopressin and methylprednisolone (VAM: a combination of vasopressin 20IU and methylprednisolone 40mg or placebo). Additional doses of vasopressin (20 IU) or placebo were administered after each additional dose of epinephrine for a maximum of 4 doses.
The primary outcome was return of spontaneous circulation (ROSC).
What did the authors find?
A: Patients in the VAM group had more ROSC and higher favorable neurological outcome at 30 days
B: Patients in the VAM group had more ROSC but equal neurological outcome at 30 days
C: Patients in the VAM group had less ROSC but higher favorable neurological outcome at 30 days
D: Patients in the VAM group had less ROSC and lower favorable neurological outcome at 30 days
The correct answer is B.
RebelEM covered the trial last week.
Patients in the VAM group had more ROSC (42% vs. 32%), but lower survival at 30 days (8,7% vs. 12%) and equal neurological outcome at 30 days (Cerebral Performance Category scale (CPC) of 1 or 2).
REBEL Cast Ep104: VAM-IHCA – Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest
Question 2
What electrolyte abnormality results in a very flat and long QT segment with an otherwise normal T-wave?
A: Hyperkalemia
B: Hypokalemia
C: Hypocalcemia
D: Hypercalcemia
E: Hypernatremia
F: Hyponatremia
The correct answer is C.
Hypocalcemia was covered on dr. Smith’s ECG blog this week.
Hypocalcemia causes a long QT without evident abnormalities in T-wave morphology.
Question 3
Your 18 month old patient presents after a simple febrile seizure. What do you tell her terrified parents?
A: Febrile seizures are very common. About half of children will have a febrile seizure.
B: The risk of recurrence is not higher than the risk of a first febrile seizure
C: Evidence suggests antipyretic medication prevents febrile seizures
D: Unfortunately, children with a febrile seizure are at increased risk for epilepsy compared to the general population, but the absolute risk is still small
The correct answer is D.
Simple febrile seizures were covered on EMdocs this week.
Children with a febrile seizure are at increased risk for epilepsy compared to the general population.
Febrile seizures affect 2-5% of children in the United States.
Children have an approximately 30% risk of recurrence.
Prophylactic antipyretics do not prevent the occurrence of febrile seizures during illness.
Pediatric Small Talk – The FAQ Approach to Simple Febrile Seizures
Question 4
In nephritic syndrome, inflammation of the glomerular basement membranes leads to passage of both red blood cells and protein into urine. Hematuria is specific to nephritis.
In nephrotic syndrome, damage to the glomerulus leads to increased passage of large molecules such as albumin into urine.
Which of the following disorders causes nephrotic syndrome?
A: Focal Segmental glomerulosclerosis
B: Hemolytic Uremic Syndrome
C: Henoch-Schonlein purpura
D: Post-streptococcal glomerulonephritis
The correct answer is A.
Taming the SRU covered nephrotic and nephritic syndromes last week.
Focal Segmental glomerulosclerosis leads to nephrotic syndrome.
Hemolytic Uremic Syndrome, Henoch-Schonlein purpura and Post-streptococcal glomerulonephritis lead to nephritic syndrome.
Question 5
C-spine tenderness is part of the NEXUS criteria and warrants imaging in trauma patients. This finding however, has very low specificity.
In this recently published study, 478 non-trauma patients were enrolled. Two examiners individually examined for midline c-spine tenderness on palpation.
What percentage of these patients had midline c-spine tenderness on palpation according to both examiners?
A: 16.4%
B: 37.8%
C: 59.8%
D: 74.1%
The correct answer is C.
This week JournalFeed discussed this article about the prevalence of midline cervical spine tenderness in non-trauma patients.
59.8% had midline c-spine tenderness on palpation according to both examiners. Most of them were female (70.6%).
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
