Quiz 149, March 18, 2022

Welcome to the 149th FOAMed Quiz.


Question 1

Source image: thesgem.com

Chest tubes for a small traumatic pneumothorax has been subject of discussion the last couple of years.

In this recently published paper, a single center implemented a guideline in which traumatic pneumothoraces of ≤35 mm in stable patients were treated conservatively. The outcomes were observation failure (patient needing a chest tube after all), length of hospital stay, complications and mortality.

A pre-guideline implementation (n=99) group was compared to a post-guideline implementation group (n=167).

After implementation of the guideline, there was a decrease in number of patients receiving chest tubes from 28.3% to 18% (p=0.04).

What else did the authors find?

A: Observation failure was higher after conservative guideline implementation

B: Observation failure was higher before conservative guideline implementation

C: No significant differences were found in observation failure

The correct answer is C.

The paper was covered on JournalFeed last week.

There was a significant increase in observation rates, while tube thoracostomies decreased. No statistically significant changes in observation failure rates, hospital or ICU length-of stay, complications, or mortality were found.

Question 2

Source image: rcemlearning.co.uk

Your 64 year old presents to the Emergency Department with acute dyspnea and chest pain. After questioning and examining the patient you suspect him to have acute heart failure (AHF).

Which statement about diagnosis of AHF is true?

A: Obese patients typically demonstrate higher BNP and NT-proBNP

B: Chest x-ray is very sensitive for the diagnosis of AHF

C: Point of care ultrasound is a reliable tool for assessing pulmonary edema in AHF

The correct answer is C

This week EMDocs covered the misconceptions and pearls about Acute Heart Failure

Natriuretic peptides include BNP and NT-proBNP which are cardiac neurohormones produced in cardiac muscle when there is myocyte stretch.

Due to less myocardial stress, obese patients may demonstrate lower BNP and NT-proBNP.

Chest X-ray has a pretty low sensitivity for AHF.

POCUS has a high sensitivity for pulmonary edema.

emDOCs Podcast – Episode 49: Acute Heart Failure Evaluation Misconceptions

Question 3

Source image: litfl.com

An ECG is essential to differentiate between acute myocardial infarction (MI) and pericarditis.

Which of the following features is more indicative for pericarditis than for MI?

Two answers are correct.

A: ST elevation II > ST elevation III

B: ST elevation III > ST elevation II

C: ST elevation > 5mm

D: Convex shaped ST elevations

E: Spodick’s sign

The correct answers are A and E.

This week Emergency Medicine Cases covered pericarditis.

In pericarditis there is widespread/diffuse PR depression and/or ST elevation. The ST elevations are more commonly concave shaped than convex.

ST elevation is rarely > 5mm in pericarditis.

Furthermore, ST elevation II > ST elevation III favors pericarditis and ST elevation III > ST elevation II is highly indicative for inferior STEMI.

Spodick’s sign is seen in approximately 80% of patients with acute pericarditis and in only 5% of STEMIs. It is characterized by down-sloping from the T wave to the QRS segments with the terminal PR segment depressed.

Ep 166 Pericarditis and Cardiac Tamponade

Question 4

Source image: dailymail.co.uk

High dose hydroxocobalamin administration (in case of cyanide intoxication) leads to a typical discoloration of urine.

What color is it?

A: Blue

B: Red

C: Green

D: Brown

The correct answer is B, red.

LITFL covered cyanide intoxication last week.

Hydroxocobalamin leads to a harmless and transient reddish colour to the skin and urine. The urine can have this colour for about a month after administration.

Raspberry urine?

Would you like to receive an e-mail every time a quiz is published? Please leave your e-mail address here:

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

Reviewed and edited by Rick Thissen