Welcome to the 151th FOAMed Quiz.
Question 1
In our emergency department, succinylcholine is very rarely used because nondepolarizing agents are thought to have a better safety profile.
Which of the following patients does NOT have an increased risk of developing succinylcholine induced hyperkalemia?
A: A patient with Guillain Barré syndrome
B: A patient with extensive trauma
C: A patient with liver disease
D: A patient with septic shock
The correct answer is C.
Succinylcholine was covered on EMDocs last week.
Succinylcholine causes prolonged depolarisation. Sodium channels are activated and cause an influx of sodium which depolarizes the cell. When this happens potassium channels also open that cause efflux of potassium, leading to hyperkalemia. This process gets significant whenever upregulation and expression of ACh receptors occurs (like in trauma of denervation).
Question 2
Your 2 year old patient presents with an inguinal bulge and you are in doubt whether this is hydrocele or an inguinal hernia. You palpate the cord structures against the pubic tubercle and it feels like 2 silk sheets rubbing over one another (positive silk glove sign).
What diagnosis is supported by a positive silk glove sign?
A: Hydrocele
B: Inguinal hernia
The correct answer is B.
Hernias were covered on DFTB last week.
A positive silk glove sign can be found in case of a patent processus vaginalis. What you actually feel is the smooth edges of the peritoneal sac. This rules out hydrocele and has a pretty decent accuracy for detection of an inguinal hernia.
Hernias
Question 3
Where can a Bezold abscess be found?
A: Groin
B: Neck
C: Armpit
D: Foot
The correct answer is B.
Bezold abscess was covered on pedEM morsels last week.
It is a complication of acute mastoiditis. An eroded mastoid cortex leads to pus spreading between the digastric and sternocleidomastoid muscles.
Bezold’s Abscess in Children
Question 4
Your 78 year old patient presents with diarrhea and vomiting. Her vital signs are normal. She had an episode of syncope with swift full recovery. The ED nurse performed orthostatic vital sign measurements and found a decrease in systolic blood pressure of 30 mmHg.
Which of the following statements about orthostatic vital signs is true?
A: In the healthy population, orthostatic hypotension is common and its frequency increases with age
B: Positional systolic blood pressure changes occur in 2-5% of patients of over 65 years of age
C: In order to obtain orthostatic vital signs, they should be measured 30 seconds after standing from a supine position
The correct answer is A.
Orthostatic vitals signs were covered on RebelEM last week.
In the healthy population, orthostatic hypotension is common and its frequency increases with age. Positional systolic blood pressure changes occur in 11 – 50% of patients > 65 years of age. In order to obtain orthostatic vital signs, they should be measured 3 minutes after standing from a supine position.
REBEL Core Cast 79.0 – Orthostatics in Volume Loss
Question 5
What is the correct dose of intravenous insulin in case of calcium channel blocker intoxication?
A: 0.01 U/kg
B: 0.1 U/kg
C: 1 U/kg
D: 10 U/kg
The correct answer is C.
Calcium channel blocker intoxication was covered on SinaiEM last week.
Yes, the correct insulin dose in calcium channel blocker and beta blocker intoxication is 1 U/kg, followed by a continuous infusion of 0.5 – 1 U/kg.
Calcium Channel Overdose
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
