Quiz 170, December 2nd, 2022

Welcome to the 170th FOAMed Quiz.


Question 1

Source image: https://en.wikipedia.org/

Pyridoxine is commonly found in food and dietary supplements. Pyridoxine is also used in the medical field as a treatment for pyridoxine deficiency, certain types of mushroom poisoning and treatment of a certain type of intoxication with tuberculosis antibiotics.

For which of the following intoxications is pyridoxine used?

A: Ethambutol

B: Rifampicin

C: Isoniazid

D: Pyrazinamide

The correct answer is C, isoniazid.

The use of pyridoxine in the medical field was covered by emDOCS last week.

One of its active forms, pyridoxal phosphate plays an important role in the synthesis of GABA. Isoniazid causes pyridoxine deficiency which leads to GABA deficiency and seizures.

ToxCard: Pyridoxine Uses in Clinical Toxicology

Question 2

Source image: http://hqmeded-ecg.blogspot.com/

The ECG shown above belongs to your patient with acute shortness of breath and hemodynamic instability.

Which of the following is the most likely reason for her illness?

A: Pulmonary embolism

B: Cardiac tamponade

C: Myocardial infarction

D: Tension pneumothorax

The correct answer is B.

This ECG was covered in dr. Smith’s ECG blog last week.

The ECG shows sinus tachycardia and a low voltage QRS with alternating amplitudes. This beat-to-beat variation in QRS amplitude and morphology is called electrical alternans and is seen in cardiac tamponade. On ultrasound you will find pericardial fluid and a ‘’swinging heart’’.

Question 3

Source image: www.emottawablog.com

Your patient presents with unilateral angio-edema. He is not in acute distress and shows no signs of acute airway compromise. He is known to have hypertension.

Which of the following antihypertensives is most likely the cause of his angio-edema?

A: Metoprolol

B: Nifedipine

C: Hydrochlorothiazide

D: Lisinopril

The correct answer is D.

EMOttawa covered ACE-inhibitor induced angioedema last week.

ACE inhibitor-induced angioedema accounts for 30% of all angioedema presentations.

Question 4

Source image: www.pixabay.com

Which of the following statements about ACE-inhibitor induced angioedema is true?

A: It is bradykinin-mediated

B: It is histamine-mediated

C: It is eosinophil-mediated

ACE-induced angioedema, although not fully understood, is a bradykinin-mediated process.
Episodic angioedema with eosinophilia (EAE) is called Gleich’s syndrome.

Question 5

Source image: www.aha.ch

Which of the following is most likely effective in treatment of ACE-inhibitor induced angioedema according to the available evidence?

A: Adrenalin

B: Fresh Frozen Plasma (FFP)

C: Icatibant

D: Dexamethasone

E: None of the above.

The correct answer is E.

So far, the available evidence shows no medications to be beneficial in ACE-inhibitor induced angio-edema.

Avoidance of airway compromise is the main goal of the therapy.

Question 6

Source image: www.multimedi.com and www.medbis.nl

What does the available evidence say about skin adhesives (glue) versus sutures for simple and non-infected wound?

A: Sutures lead to better cosmesis and lower pain scores but a slightly lower rate of wound dehiscence compared to skin adhesives

B: Sutures lead to equal cosmesis and equal pain scores and an equal rate of wound dehiscence compared to skin adhesives

C: Sutures lead to equal cosmesis, higher pain scores and a slightly lower rate of wound dehiscence

D: Sutures lead to worse cosmesis, equal pain scores but a slightly lower rate of wound dehiscence compared to skin adhesives

The correct answer is C.

Wound closure techniques were covered on first10EM last week.

Using skin glue has benefits over sutures. It is faster and it leads to lower pain scores. Cosmesis is equal. Wound dehiscence is almost certainly more common, although this doesn’t seem to have any impact on long term outcomes.

Lacerations: Does closure technique matter?

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This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Nicole van Groningen, Jeroen van Brakel, Noortje Geerts and Renée Deckers

Reviewed and edited by Rick Thissen