Quiz 145, February 18th

Welcome to the 145th FOAMed Quiz.


Source: www.pixabay.com

Question 1

A routine urinalysis comes back clearly positive for a urinary tract infection. Among the results is the urine pH. You intend to treat it with nitrofurantoin.

What does an urine pH ≥8 say about possible nitrofurantoin resistance?

A: Nothing

B: More likely to be resistant

C: Less likely to be resistant

The correct answer is B.

This week JournalFeed discussed Alkaline Urine and Nitrofurantoin resistance.

Proteae group bacteria, more often resistant to nitrofurantoin, are urease producing, which often makes the urine pH alkaline. This recently paper found that for a urine pH 5-7, 80% of cultures were sensitive to nitrofurantoin, but for a urine pH >9 just 54.6% were sensitive.

Source: http://app.wizer.me

Question 2

The efficacy of topical tranexamic acid (TXA) in epistaxis remains controversial. The NoPac RCT, published last year, failed to demonstrate superiority of topical TXA compared to placebo at controlling bleeding and reducing the need for anterior nasal packing.

Recently a systematic review and meta-analysis about this topic was published. A total of eight studies were included in the analysis, including seven randomized trials and one retrospective study. A total of 1299 patients were included, of which 46% received TXA while 54% received control treatment.

What did the authors of this systematic review and meta-analysis find?

A: Placebo was more effective in controlling bleeding compared to topical TXA

B: Placebo and topical TXA were equally effective in controlling bleeding

C: Topical TXA was more effective in controlling bleeding compared to placebo

The correct answer is C.

The paper was covered on JournalFeed last week.

Patients who were treated with TXA were 3.5 times more likely to achieve bleeding cessation at the first assessment and had a 63% less likelihood of returning due to rebleeding at 24-72 hours.

Source: www.pixabay.com

Question 3

Which of the following statements about febrile seizures is true?

A: Keeping the temperature down will stop the child having a febrile convulsion

B: Children who have had a simple febrile convulsion have a slightly higher risk than the general population of developing epilepsy

C: Simple febrile convulsions can cause brain damage or long-term problems

D: Febrile convulsions often need medication to stop them

The correct answer is B.

Febrile seizures was covered on Don’t Forget the Bubbles last week.

Children who have had a simple febrile convulsion have a slightly higher risk than the general population of developing epilepsy

5 febrile convulsion myths

Question 4

Source image: litfl.com

You are performing procedural sedation on a 4 year old child for abscess drainage. 10 minutes after Ketamine administration she develops a stridor and becomes hypoxic.

Which of the following options is not indicated as treatment for larygospasm?

A: Positive Pressure Ventilation

B: Deeper sedation using propofol

C: Administration of paralytic agent

D: Try to wake the child up

The correct answer is D.

PedEM Morsels covered laryngospasm last week.

Trying to wake the child up (or proceeding with a painful procedure) will most likely make laryngospasm worse.

You can try pressing the laryngospasm notch behind the earlobe and the mandible’s ramus, but most of all you have to stop all stimuli and if needed deepen sedation (I would you propofol in this case). Further down the road of troubles you can intubate after administration of a paralytic agent.

Ketamine and Laryngospasm

Question 5

Which of the following pathogens is most common in cellulitis?

A: Group A Streptococcus

B: Staphylococcus aureus

C: Haemophilus influenzae type B

D: Neisseria meningitidis

The correct answer is A.

Cellulitis was covered on EMDocs last week.

The most common cause of cellulitis are beta-hemolytic streptococci (groups A, B, C, G, and F) and most commonly group A Streptococcus.

EM@3AM: Cellulitis

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

Reviewed and edited by Rick Thissen