Quiz 185, March 31, 2023

Welcome to the 185th FOAMed Quiz.


Question 1

Source image: www.healio.com

The timing of cardiac catheterisation in patients with return of spontaneous circulation (ROSC) after out of hospital cardiac arrest (OHCA) in the absence of ischemic changes on the ECG remains subject of debate.

In the EMERGE trial, 279 patients with ROSC after OHCA without clear evidence of cardiac ischemia on ECG and without any obvious cause of their cardiac arrest were randomized to either delayed (performed after 48-96 hour) (n=138) or emergent CAG (n=141).

The primary outcome was 180-day survival rate with Cerebral Performance Category (CPC) < 2 (independent activities of daily life).

What did the authors find?

A: Patients in the early CAG group had higher 180-day survival with good neurologic outcome compared to patients in the emergent CAG group

B: Patients in the delayed CAG group had higher 180-day survival with good neurologic outcome compared to patients in the emergent CAG group

C: There was no difference between the groups

The correct answer is C.

The EMERGE trial was covered on RebelEM last week.

The mean time delay between randomization and CAG was 0.6 hours in the emergent CAG group and 55.1 hours in the delayed CAG group. The 180-day survival rates among patients with a CPC of 2 or less were 34.1% (47 of 141) in the emergency CAG group and 30.7% (42 of 138) in the delayed CAG group (P = .32).

Keep in mind that the study was stopped early due to insufficient enrollment. Investigators enrolled approximately 280 patients out of 970 planned.

The EMERGE Trial: Emergency vs Delayed Catheterization in Survivors of Out-of-Hospital Cardiac Arrest

Question 2

Source image: nl.pinterest.com

Combine the incomplete spinal cord injury types with the correct set of symptoms.

1: Brown-Sequard syndrome

2: Central cord syndrome

3: Anterior cord syndrome

A: Disproportionately greater motor impairment in upper compared with lower extremities, bladder dysfunction, and a variable degree of sensory loss below the level of injury

B: Motor paralysis below the level of the lesion as well as the loss of pain and temperature at and below the level of the lesion

C: Loss of motor function, loss of vibration sense and fine touch, loss of proprioception and signs of weakness on the ipsilateral side and loss of pain and temperature sensation and crude touch 1 or 2 segments below the level of the lesion on the contralateral side

The correct answer is 1C, 2A, 3B

Spinal fractures were covered on Geekymedics last week.

The dorsal columns travel in the posterior section of the spinal cord and carry information about fine touch. The fibers remain ipsilateral and do not decussate until they reach the medulla of the brainstem.

The spinothalamic tracts travel in the anterior part of the spinal cord and carry information regarding pain and temperature. The fibers decussate as soon as they enter the spinal cord and ascend contralaterally.

The corticospinal tract carries motor information from the motor centers of the frontal lobe down to the skeletal muscles. The fibers descend contralaterally.

Spinal Fractures

Question 3

What is not a name for the fracture in the picture below?

A: The tripod fracture

B: Zygomaticomaxillary complex fracture

C: Malar fracture

D: Lateral triangular fracture

Source image: www.thetraumapro.com

The correct answer is D.

The trauma pro covered the tripod fracture this week; also known as zygomaticomaxillary complex fracture or malar fracture. Fundamentally, the zygoma is separated from the rest of the face. There are, as the name suggests, three components of this fracture. The zygomatic arch, the floor of the orbit (and includes the maxillary sinus) and the lateral orbital rim and wall.

What Is: The Tripod Fracture?

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

Reviewed and edited by Rick Thissen