Quiz 30. week 15. 2019

Question 1

Which of the following glucose lowering medications gives the highest chance on euglycemic diabetic ketoacidosis?

A: Metformin

B: Gliclazide (Sulfuronyl derivates)

C: Canagliflozin (SGLT-2 inhibitor)

D: Acarbose (Alpha Glucosidase inhibitor)

The correct answer is C

The SGLT2 inhibitors (like Canaglifozin) are notorious for causing an euglycemic diabetic ketoacidosis. This post on County EM is about challenges in the diagnosis of diabetic ketoacidosis.

Diagnosis of Diabetic Ketoacidosis – What about beta-hydroxybutyrate level?

Question 2

Source: https://hqmeded.com/

Which of the following statements is true about peritonsillar abscess drainage?

A: Ultrasound can be used as an aid for diagnosis and localization, preferably using a submandibular approach

B: Even in the case of severe trismus, you can safely drain the abscess in the Emergency Department

C: A 24 gauge spinal needle is suitable for abscess drainage

D: All patients should receive antibiotics after successful drainage

The correct answer is D

Daniel Ballew wrote a nice overview on peritonsillar abscess drainage on emDOCs.

Peritonsillar abscess is the most common deep space infection of the head and neck. Diagnosis is generally clinically made. Ultrasound (using the endocavitary probe) can be used to check for a collection on fluid (and so for guidance). Alternatively a submandibular approach can be used to visualize the abscess. Use a 18 G needle. Management consists of drainage followed by antibiotics.

Unlocking Common ED Procedures – Peritonsillar Abscess Drainage

Question 3

Recently another paper was published about contrast induced nephropathy. Although the existence of this phenomena is very uncertain, it still causes delay in diagnostic imaging of sick patients. This is a large retrospective study. The authors looked at 4171 Emergency Department (ED) visits, in which 1464 tomes a patient received Contrast Enhanced CT (CECT), 976 received Unenhanced CT and 1731 had no CT. What do the results of this most recent paper about this topic show?

A: There was a significant higher incidence of Acute Kidney Injury (AKI) in the CECT group, compared to the other groups

B: There was no significant difference in incidence of Acute Kidney Injury (AKI) in the CECT group, compared to the other groups

C: The incidence of Acute Kidney Injury (AKI) was lowest in the ‘’no CT’’ group

The correct answer is B

Salim Rezaie from REBELem wrote about this trial.

As it turns out the incidence of AKI in the CECT group was 7.2%, in the Unenhanced CT 9.4% and in the No CT- group 9.7%. Looks like another nail in the coffin of contrast induced nephropathy.

https://rebelem.com/contrast-induced-nephropathy-a-modern-day-medical-myth/

Question 4


Which of the following statements about ear laceration repair is true?

A: There is no need to cover all exposed cartilage

B: Antibiotics are never indicated in ear lacerations

C: Most ear lacerations can be closed by carefully re-approximating the skin

D: An auricular field block is less beneficial than local infiltration

The correct answer is C

Sean Fox wrote about ear laceration repair in Pediatric EM morsels (but this hold true for adults as well).

Do cover exposed cartilage with skin. Most lacerations can be closed by carefully re-approximating the skin as the underlying cartilage will be approximated as well. If you need to suture cartilage, use a 4-0 or 5-0 absorbable suture. Consider antibiotics in big, dirty wound or if there is cartilage involvement. An auricular field block is more beneficial than local infiltration.

External Ear Lacerations

Question 5

Risk stratifying patients after syncope or near syncope remains a challenge in our department. A recently published paper looks at High Sensitive Troponin T (HsTnT) and NT-proBNP in patient with syncope and if there was a correlation with a primary outcome of a composite of 30 day mortality and overall cardiac badness. What did the results show?

A: Elevated HsTnT and NT-proBNP are both independent risk factors of 30 day death and serious outcomes

B: An elevated HsTnT is an independent risk factor of 30 day death and serious outcomes, whereas elevated NT-proBNP is not

C: An elevated NT-proBNP is an independent risk factor of 30 day death and serious outcomes, whereas elevated HsTNT is not

D: Neither elevated HsTnT nor NT-proBNP are independent risk factors of 30 day death and serious outcomes

The correct answer is A

Simon Laing and Rob Fenwick discuss (and smash) this paper in the ever enjoyable Papers of the Month on the Resus Room Podcast.

It looks like this retrospective paper shows a benefit in testing HsTnT and NT-proBNP in every patient presenting with syncope. However, there seem to be some methodological issues. First of all the authors use a composite outcome including death and a lot less serious problems (like atrial fibrillation), which are not really in the same league. Furthermore, both biomarker tests have a really low specificity for serious badness.

Anyway, I don’t think we should start running troponines and BNP’s in every syncope patient.

Their website seems to be down for the moment. Please click on the logo for the podcast.

This quiz was written by Eefje Verschuuren, Nathalie Dollee and Kirsten van der Zwet


 

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