Welcome to the 166th FOAMed Quiz.
Question 1
Which of the following risk scores is developed for necrotizing soft tissue infections?
A: EDACS
B: LRINEC
C: ADD-RS
D: ABCD2
The correct answer is B
Necrotizing soft tissue infections were covered on EMDocs last week.
EDACS stands for Emergency Department Assessment of Chest Pain Score.
ADD-RS is the Aortic Dissection Detection Risk Score.
The ABCD2 score is used to estimate risk of stroke (CVA) after a transient ischemic attack (TIA).
The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score was developed to distinguish necrotizing fasciitis from severe cellulitis. However, its sensitivity and specificity are pretty low so it is pretty much useless.
Question 2
Your 50 year old patient with alcoholic liver disease presents with altered mental status and a fever. On POCUS you find extensive free intraperitoneal fluid and you suspect Spontaneous Bacterial Peritonitis (SBP).
Which of the following findings makes the diagnosis less likely?
A: Serum CRP of 5 mg/L
B: Ascites pH of 7.40
C: Ascites neutrophil count of 350 cells/mm3
D: Negative ascites gram stain
The correct answer is B
Spontaneous bacterial peritonitis was covered on RebelEM last week.
Serum CRP is not beneficial in the diagnosis of SBP.
An ascites neutrophil count of > 250 cells/mm3 makes the diagnosis more likely.
The gram stain of ascites is generally negative in SBP.
A normal pH (or pH gradient of < 0.10) correlates with a low likelyhood ratio (LR = 0.12). Source
REBEL Core Cast 89.0 – Spontaneous Bacterial Peritonitis
Question 3
Your 89 year old patient has fallen in her home and presents to you with pelvic pain. Conventional X-ray of the pelvis was negative but she remains unable to walk. You wonder what the chance is of an occult fracture.
This recently published retrospective study is about the diagnostic value of conventional imaging in suspected pelvic injury in patients of 65 years and older. 177 patients were included, with a total of 555 fractures. All patients had an X-ray and CT scan of the pelvis.
What was the sensitivity of plain radiographs?
A: 28%
B: 48%
C: 68%
D: 88%
The correct answer is B.
UMEM mentioned the paper in their pearls section last week.
Global pooled sensitivity for pelvic radiographs in detecting pelvic fractures compared to CT was 48%, with a specificity of 93%. Sensitivity was lowest in Sacrum and Ilium fractures.
18 patients were treated with surgical fixation of which in only half the cases the fractures were appreciated on plain radiographs by both examiners.
Question 4
Patients with acute pancreatitis generally receive large amounts of iv fluid.
This recently published multicentre randomised controlled trial (the WATERFALL study) is about aggressive versus moderate fluid administration in patients with acute pancreatitis.
Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour.
A total of 249 patients were included in the interim analysis. The primary outcome was development of moderately severe or severe pancreatitis during hospitalisation. The main safety outcome was fluid overload.
What did the authors find?
A: Development of moderately severe or severe pancreatitis was more common in the aggressive fluid resuscitation group. Fluid overload was also more common in the agressive fluid resuscitation group.
B: Development of moderately severe or severe pancreatitis was more common in the aggressive fluid resuscitation group but there was no difference in rate of fluid overload between the groups
C: Development of moderately severe or severe pancreatitis was equal between the groups but fluid overload was more common in the aggressive in fluid group
D: Development of moderately severe or severe pancreatitis was equal between the groups and there was no difference in rate of fluid overload
The correct answer is C.
The paper was covered on First10EM last week.
The incidence of moderately severe or severe pancreatitis was 22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group (p = 0.32). Fluid overload developed in 20.5% of patients in the aggressive resuscitation and in 6.3% of those who received moderate resuscitation (P = 0.004).
The trial was halted due to this difference in the safety outcome without a significant difference in the incidence of moderately severe or severe pancreatitis.
Research Roundup October 2022
Question 5
Adverse reactions of immunotherapy in treatment of cancer are quite common. They include colitis, pneumonitis and endocrine dysfunction among many others.
Until what time after immunotherapy treatment is seized can these complications occur?
A: 2 days
B: 2 weeks
C: 2 months
D: 2 years
The correct answer is D
Taming the SRU covered complications of immunotherapy last week.
Adverse reactions can occur up to 2 years after immunotherapy.
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
