Welcome to the 165th FOAMed Quiz.
Question 1
Your patient presents with a triad of ophthalmoplegia, ataxia, and areflexia.
Which variant of Guillain-Barré syndrome fits best?
A: Acute inflammatory demyelinating polyneuropathy (AIDP)
B: Acute motor axonal neuropathy (AMAN)
C: Acute motor sensory axonal neuropathy (AMSAN)
D: Miller-Fisher syndrome
The correct answer is D.
Geeky Medics covered Guillain-Barré syndrome last week.
Miller-Fisher syndrome is typically associated with a triad of ophthalmoplegia, ataxia, and areflexia
Guillain-Barré Syndrome
Question 2
Winter is coming.
This retrospective, observational paper published earlier this year is about prostaglandin (iloprost) in frostbite. 90 patients with grade 2-4 frostbite injuries were included. 26 were treated with 5-day intravenous prostaglandin, compared to 64 patients who received usual care.
The primary outcome was the rate of affected digits amputated.
What did the authors find?
A: Significantly lower digital amputation rates were observed for patients with severe (grade 3 and 4) frostbite injuries treated with iloprost versus usual care
B: Significantly lower digital amputation rates were observed for patients with severe (grade 3 and 4) frostbite injuries treated with usual care versus iloprost
C: There was no difference between the groups
The correct answer is A
CanadiEM covered the paper last week.
Significantly lower digital amputation rates were observed in patients with more severe frostbite injuries treated with iloprost versus usual care: Grade 3 (18% vs 44%, p < 0.001), Grade 4 (46% vs 95%, p < 0.001).
CJEM Visual Abstract: IV Prostaglandin to Reduce Digital Amputations in Frostbite
Question 3
Which of the following structures is most likely damaged in a patient with this X-ray?
A: Anterior Cruciate Ligament (ACL)
B: Posterior Cruciate Ligament (PCL)
C: Medial collateral ligament (MCL)
D: Lateral collateral ligament (LCL)
The correct answer is A
EM cases covered frequently missed diagnoses last week.
The depression on the lateral femoral condyle is called a deep sulcus terminalis sign or simply lateral femoral notch sign. It suggests an ACL tear.
Ep 175 Emergency Orthopedics Differential: SCARED OF Mnemonic – When X-rays Lie
Question 4
Your patient presents with a small complex tachycardia of 160 bpm. He is hemodynamically stable. 6 mg Adenosine converted the rhythm to sinus for about 10 seconds, but it relapsed into an AVNRT.
Which of the following treatment options is not a reasonable next step?
A: Adenosine 12 mg
B: A Beta Blocker
C: A Calcium Antagonist
The correct answer is A
A case just like this one has been covered on dr. Smith’s ECG blog last week.
Adenosine converted the rhythm, but this only lasted for some seconds. A higher dose will most likely do just the same. You need something that converts the rhythm and acts longer. Both an intravenous calcium antagonist or intravenous beta blocker will likely do the job.
Question 5
We are all taught that you should not give nitroglycerin in acute right ventricular infarction (RVMI) due to risk of compromised right ventricular ejection fraction.
This recently published meta-analysis included 5 papers (1113 patients). The outcome consists of all forms of adverse events reported in literature.
What did the authors find?
A: No, there is no statistically significant difference in the rate of adverse events when nitrates are administered to RVMI compared with other cardiac regions. However, the adverse events were major.
B: No, there is no statistically significant difference in the rate of adverse events when nitrates are administered to RVMI compared with other cardiac regions. Furthermore, the adverse events were only minor.
C: Yes, there is a statistically significant difference in the rate of adverse events when nitrates are administered to RVMI compared with other cardiac regions and the adverse events were major.
D: Yes, there is a statistically significant difference in the rate of adverse events when nitrates are administered to RVMI compared with other cardiac regions but the adverse events were only minor.
The correct answer is B.
EMCrit covered the meta-analysis last week.
This meta-analysis did find a non-statistically significant difference in adverse event rates
from nitrates based on the cardiac region of the infarction. These adverse events were noted to be minor and transient.
EMCrit Wee – Is there Evidence of Harm for Nitroglycerin in Right Ventricular MI? #Dogmalysis
This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Gijs de Zeeuw, Nicole van Groningen, Jeroen van Brakel, Noortje Geerts and Renée Deckers
Reviewed and edited by Rick Thissen
