Quiz 178, February 3, 2023

Welcome to the 178th FOAMed Quiz.


Source image: www.facialpalsy.org.uk

Question 1
Evidence suggests steroids are beneficial for Bell’s Palsy in adults, but in children data is lacking.

In this paper, published august 2022, 187 children with Bells palsy were randomised to treatment with prednisolone (n=93) and to placebo (n=93).

The primary outcome was complete recovery of facial function at 1 month defined by a House-Brackmann score of 1.

What did the authors find?

A: The percentage of children with complete recovery was significantly higher in the group of children receiving prednisolone compared to the placebo group

B: There was no significant difference in percentage of children with complete recovery.

C: The percentage of children with a complete recovery was significantly lower in the group of children receiving prednisolone compared to the placebo group

The correct answer is B.

The SGEM covered the paper last week.

At 1 month, the proportions of patients who had recovered facial function were 49% (n=43/87) in the prednisolone group compared with 57% (n=50/87) in the placebo group (95% CI -22.8 to 6.7). At 6 months recovery was 99% (n=77/78) in the prednisolone groups and 93% (n=76/82) in the placebo group (CI -0.1 to 12.2).

SGEM#390: I Can’t Feel My Face when I Have Bell Palsy, but will Steroids Help?


Source image: www.pixabay.com

Question 2

Which of the following drugs may be added to N-acetylcysteine in the treatment of acetaminophen overdose?

A: Flumazenil

B: Pyridoxine

C: Ethanol

D: Fomepizole

The correct answer is D.

Fomepizole for Acetaminophen Toxicity was covered on EMDocs last week.

Fomepizole is known for treatment of toxic alcohol poisoning. However, it seems to reduce conversion of acetaminophen to NAPQI and some other things that may help in acetaminophen poisoning.

ToxCard: Fomepizole for Acetaminophen Toxicity

Source image: www.pixabay.com

Question 3

A healthy woman is pregnant for the first time. She is known to have an abnormal dystrophin gene which makes her a Duchenne Muscular Dystrophy (DMD) carrier. The sex of the unborn child is not known yet. The father is a healthy man.

What is the chance the child will have DMD?

A: 25%

B: 50%

C: 75%

D: 100%

The correct answer is A.

DMD was covered on DFTB last week.

DMD is inherited as an X-linked recessive disorder from a mother who carries a mutation. However one-third of cases are due to de novo mutations.

A mother who is a carrier of an X-linked recessive disorder will have a 50 percent chance of passing it on. This means she has a 25% chance of having an affected son and a 25% chance of having a carrier daughter.

Source image: duchenneandyou.co.uk

Duchenne Muscular Dystrophy

Source image: www.alba-healthcare.com

Question 4

Are we still administering too much oxygen to patients after cardiac arrest?

The EXACT trial was published in November 2022. 425 unconscious adults with return of spontaneous circulation after out of hospital cardiac arrest (OHCA) were included in the primary analysis. These patients were randomised by paramedics to receive oxygen titration to achieve an oxygen saturation of either 90% to 94% (intervention; n = 216) or 98% to 100% (standard care; n = 212) until arrival at the intensive care unit.

The primary outcome was survival to hospital discharge.

What did the authors find?

A: Survival to hospital discharge was higher in the low oxygen group compared to the high oxygen group

B: Survival to hospital discharge was lower in the low oxygen group compared to the high oxygen group

C: Survival to hospital discharge was equal between the two groups

The correct answer is B.

The paper was covered in EMDocs last week.

38.3% of patients in the intervention group survived to hospital discharge compared to 47.9% of patients in the standard care group ([95% CI, -18.9% to -0.2%]; unadjusted odds ratio, 0.68 [95% CI, 0.46-1.00]; P = .05)

Keep in mind the trial was stopped early because of the COVID pandemic. Furthermore, the trial suggests harm of the intervention (less patients survived to hospital discharge and more patients had an hypoxic event). However, the trial was not designed to detect harm, so this is actually a negative trial and this conclusion cannot be drawn with certainty.

52 in 52 – #26: The EXACT Trial

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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