Quiz 168, November 18th, 2022

Welcome to the 168th FOAMed Quiz.


Question 1

Source image: www.wikipedia.org

What kind of device is this?

A: Implantable cardioverter defibrillator (ICD)

B: Regular pacemaker

C: Biventricular pacemaker

The correct answer is A.

The thick coils are found in ICD’s, not in pacemakers.

The Pacemaker

Question 2

Source image: www.sinaiem.org

This ECG belongs to a patient with a pacemaker (obviously).

What is going on?

A: Failure to pace

B: Failure to capture

C: Failure to sense

The correct answer is C.

There is a pacemaker spike present just before the p-wave and a spike after the start of the QRS. The QRS simply cannot be narrow when the pacemaker is conducted, so this is the patient’s native conduction at work. 

The Pacemaker

Question 3

Source image: www.doczero.com

What happens (most likely) if you put a magnet on a pacemaker?

A: It shuts down and will not pace anymore

B: It will pace in a fixed rate (VOO)

C: It will go into DDD mode

The correct answer is B.

The pacemaker should go into VOO mode when a magnet is placed on top of it. This means it will stop ‘’thinking’’ and just paces at a fixed rate.

The Pacemaker

Question 4

Source image: www.medtronic.com

And the last one on pacemakers. Which of the following is a real pacemaker problem?

A: Faraway pacemaker

B: Takeaway pacemaker

C: Fadeaway pacemaker

D: Runaway pacemaker

The correct answer is D. SinaiEM covered pacemaker problems last week. Runaway pacemaker is something you never hope to see: a total pulse generator malfunction in which the pacemaker creates rapid and unsustainable pulses. If conducted, this generates a potentially lethal ventricular arrhythmia. Cutting the pacemaker wires will save the life of your patient.
The Pacemaker

Question 5

Source image: www.hartcentrumhasselt.be

Acute aortic dissection (AAD) requires rapid diagnosis and treatment.

On POCUS, which view can be used for the identification of an intimal flap in the aortic arch?

A: Parasternal long axis view

B: Suprasternal notch view

C: Abdominal aorta view

D: Subxyphoidal view

The correct answer is B

EMDocs covered POCUS for aortic dissection in the clinical presentation of ischemic stroke last week.

A suprasternal notch view is acquired by placing the (phased array) transducer in the suprasternal notch and rotating the length of the probe between the left sternocleidomastoid muscle and the right clavicular head. The aortic arch and its branches can be visualised.

POCUS for aortic dissection in the clinical presentation of ischemic stroke

Question 6

Source image: www.acepnow.com

Ultrasound assistance for lumbar punctures is used more and more regularly. It provides an opportunity to visualise and mark the spinous processes and the midline (and visualise the ligamentum flavum).

The most recent meta-analysis on this topic dates from 2019 and includes a total of 957 patients.

What did this meta-analysis show?

A: There was a statistically significant higher success rate when using ultrasound assistance versus a ‘blind’ procedure

B: There was no difference in success rate between ultrasound assistance and ‘blind’ procedure

C: There was a statistically significant higher success rate when using a ‘blind’ procedure versus ultrasound assistance

The correct answer is A

SinaiEM covered ultrasound assisted lumbar puncture last week.

In this meta-analysis, there was a statistically significant increase in success rate as well as decrease in procedure time, fewer passes with the needle, and decrease in pain score when comparing ultrasound assisted lumbar puncture versus a blind procedure.

POCUS guided LP

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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