Welcome to the 184th FOAMed Quiz.
Question 1
Thyroid storm has a mortality rate of 100% if untreated and if treated it is 30-40%. It is a clinical syndrome that is important to be recognised.
Which of the following drugs should be given first in the management of thyroid storm?
A: Iodine
B: Dexamethasone
C: Propranolol
D: Propylthiouracil (PTU)
The correct answer is D.
Thyroid storm was covered at EMOttawa this week.
Thyroid storm is ultimately a clinical diagnosis based on the triad of symptoms pyrexia, altered mental status and tachycardia. Keep in mind this triad of symptoms is non-specific for thyroid storm.
The first drug to administer is PTU. Iodine should be delayed at least one hour after the administration of PTU, for iodine could stimulate thyroid hormone synthesis.
Question 2
Which of the following trauma patients should receive Rhesus D immunoglobulines?
A: A 30 weeks pregnant patient who is rhesus D positive with profound hemorrhagic shock after a motor vehicle accident
B: A 30 weeks pregnant patient who is rhesus D positive with a traumatic head injury after a seizure
C: A 30 weeks pregnant patient who is rhesus D negative with a complicated tibia and fibula fracture after twisting the ankle on the sidewalk
D: A 30 weeks pregnant patient who is rhesus D negative and who was punched in the abdomen and has a negative Kleihauer-Betke-test
E: None of the above
The correct answer is D.
SinaiEM covered trauma in pragnancy last week.
All pregnant Rh-negative trauma patients should receive Rh immunoglobulin therapy unless the injury is remote from the uterus.
A negative Kleihauer-Betke-test does not exclude minor degrees of fetomaternal hemorrhage that are capable of immunizing the mother.
Trauma in Pregnancy
Question 3
Your 34 year old patient was bitten by a snake that escaped the terrarium at his friend’s home. He didn’t bring the snake, but shows you a picture.
Which of the following snakes is venomous?
The correct answer is B.
PedEM morsels covered snake bites last week.
A is a nonvenomous milk snake. To be distinguished from B, which is a venomous coral snake. The following rhyme is sometimes used to remember them: “Red on yellow, kill a fellow. Red on black, venom lack.”
C is a green tree python (a constrictor, also nonvenomous) and D is a rat snake, which might have a little bit of venom but poses no threat to humans.
Snake Bites and Children
Question 4
Your 23 year old patient with Sickle Cell Disease presents with fatigue, shortness of breath and profound anemia. You suspect aplastic crisis. Which of the following viruses does most likely cause aplastic crisis in Sickle Cell Disease:
A: CMV
B: EBV
C: Parvovirus
D: Herpes zoster
The correct answer is C.
SinaiEM covered complications of Sickle Cell Disease this week.
Aplastic crisis is commonly due to Parvovirus B19, so the patient may report a viral prodrome.
Sickle Cell Disease Emergencies
This quiz was written by Sophie Nieuwendijk, Denise van Vossen, Nicole van Groningen, Noortje Geerts and Renée Deckers
Reviewed and edited by Rick Thissen
