Update quiz February 2015

Types of scalp haematoma associated with increased risk of significant intracranial injury including: any scalp haematoma in infants < 3 months of age; non frontal haematoma > 1cm in diameter or a frontal haematoma > 3cm diameter. (link)

An arterial lactate of > 2mmol/L is only 65% sensitive, but 95% specific for the presence of severe sepsis or septic shock. (link)

Informed consent is the process of ensuring patients are aware of all the risks and benefits of a procedure relevant to them. This includes rare events that might be important to the patient. Full information to allow informed consent is not required if: it is common knowledge; the patient is already aware of the information (e.g. from an identical prior procedure); or if the situation is a true emergency (link)

An ED  patient with a negative 2 point US and a negative D dimer is considered at such low risk that they do not require any further investigation for DVT. If the 2 point US is negative, but the D dimer is elevated (or not performed) then follow up US in 4-7 days is usually recommended. (link)

The jejunal loops are normally < 2.5 cm in diameter – a diameter > 2.5cm is suggestive of bowel obstruction and diameters > 3cm making bowel obstruction highly probable. (link)

Ileus is least likely to have dehydration present.  Sparse bowel sounds, gas fluid levels of non distended bowel on an erect AXR would be expected.(link)

If one or more of the following features are present, then the probability that a sore throat is due to Streptococcal infection is greater than 50%: tonsillar exudate, absence of coryza and cough, cervical lymphadenopathy or scarlatiniform rash. Difficulty swallowing is a non specific symptom that can occur with many different causes of pharyngitis. (link)

Diabetic patients with cellulitis need antibiotic cover that will include gram negatives and anaerobes. Flucloxacillin and vancomycin are inadequate to do this. Ciprofloxacin and clindamycin can be used, but are reserved for severe infections and clindamycin is given as a 900mg IV slow infusion 8 hourly, not orally in this case. (link)

Hyperbaric oxygen therapy may be used as an adjunct (if available), however is not a first line treatment. (link)

The normal term newborn usually has a SpO2 of 50-60 at birth. This improves over the next few minutes in children who are breathing so that most lose their blue appearance by 3 minutes. Despite that, SpO2 may still take up to 10 minutes after delivery to reach 85%.(link)

Pupils are usually dilated in serotonin toxicity and normal in NMS. Muscle tone, temperature changes and conscious state can be changed in both NMS and serotonin toxicity, although usually more markedly effected in NMS. (link)

FEIBA (Factor eight inhibitor bypass activity) is used in patients with Haemophilia A who have inhibitors and in the treatment of NOAC toxicity. It does not contain antithrombin III concentrate (Thrombotrol does). It is produced from pooled plasma and comes as a using recombinant technology. It comes as sterile lyophilised powder given IV after reconstitution.(link)

AST and ALP values are usually falsely depressed by haemolysis.(link)

HCO3 is probably best avoided in this situation as nebulised salbutamol provides similar effects without the risk of fluid overload.(link)

Resuscitation is not usually indicated in a newborn of less than 23 weeks (not 28 weeks), due to the poor outcome. Confirmed trisomy 13 or 18, anencephaly or birth weight of < 400g are other reasons to terminate (or not commence) resuscitation. (link)

An area under the ROC of 0.5 (which is the lowest value possible) means the test is completely useless and adds no additional diagnostic information. AUC values that indicate the degree of usefulness of a test are as follows: 1 – perfect; 0.9-1 – excellent; 0.8-0.9 – good; 0.7-0.8 – fair; 0.6-0.7 – poor; 0.5-0.6 – useless. (link)

Epsilon waves are only present in 25% of cases however are highly specific. Delta waves are present in ventricular pre-excitation syndromes, whilst inverted T waves and downward sloping ST segments in V1-2 occur in Brugada syndrome. An S:T ratio of > 4 suggests an LV aneurysm. (link)

Empyema characteristically causes a pleural effusion that has a flattened meniscus level due to the density of the inflammatory pleural fluid. None of the others options would likely to be present, although extrapleural fluid might rarely be present if the empyema has developed from a penetrating wound or an invasive soft tissue infection. (link)

The normal QRS amplitude is ≥ 5 mm in each limb lead and ≥ 10 mm in each precordial lead and varies according to body habitus and patient size. Amplitude can decrease in severe hypovolaemia, usually most prominent in lead V5.(link)

Ebola PPE requires no skin is allowed to be exposed by the use of: disposable surgical scrubs (to replace street clothes, excluding underwear); disposable long-sleeved impermeable gown; disposable leg/foot covers; disposable full-face visor; disposable balaclava or suitable hood to cover head and neck; and 2 pairs of gloves, longer length to cover wrists (e.g. surgical gloves). A N95 / P2 mask is required – a standard surgical mask is insufficient. (link)