Conference Review Questions February 2nd, 2012

A few review questions from last week's conference.. same format, new home!

1.  You are reviewing the evidence in support of the Ottawa ankle rules and find articles supporting the initial creation of the rule, as well as multiple small and large prospective studies validating the rule in various clinical and geographic settings.  Based on this literature search, what level of evidence have you found in support of this clinical decision rule?

a)      Level 1

b)      Level 2

c)       Level 3

d)       Level 4

2.   According to the most recent Clinical Practice Guidelines on the Management of Community Acquired Pneumonia (CAP) in children by the Pediatric Infectious Disease Society of America, a chest radiograph is NOT indicated in which of the following patients.

a)      A 3 year old immunized patient who returns to the ED with increased work of breathing and persistent fevers 2 days after being started on amoxicillin for pneumonia as an outpatient

b)      A 3 year old immunized non-toxic patient with 1 day of fever and cough, with scattered crackles and an O2 sat 89% on RA

c)       A  3 year old immunized non-toxic patient with 3 days of fever, cough, and R sided crackles, breathing comfortably and drinking juice, 99% on RA

d)      A 2 year old immunized patient with 2 days of fever, cough, R sided crackles, with tachypnea and subcostal retractions, 95% on RA

e)      None of the above

3.   You are called to a medical alert for a 2 year old F who is carried in by her parents, she has been actively seizing for approximately 20 minutes, and no further history is available.  Your first management priority as you begin your assessment and treatment is to:

a)      Administer 100% O2 by face mask
b)      Obtain IV access

c)       Prepare RSI meds

d)      Administer  IM midazolam

e)      Obtain istat lytes and a glucose

4.  A 10 year old M with a history of migraines presents with a persistent headache despite the use of ibuprofen and Tylenol at home.  He reports that he has been using ibuprofen multiple times a week for the last several weeks with brief improvement in symptoms, only for the headache to return within several hours.  He is otherwise well appearing, afebrile, with a normal neurologic exam.  You suspect that the patient is suffering from a 'rebound headache'.   All of the following are true regarding medication overuse headaches (MOH) except:

a)      Headache is present for >= 15 days a month

b)      Simple analgesics (i.e. ibuprofen) must be used on >=15 days a month for more than 3 months

c)       Migraine is the most common headache associated with MOH

d)      MOH cannot be caused by overuse of triptans

5.   Which of the following is a true statement regarding medications used in the treatment of migraine headaches?

a)      Oral formulations of triptans are more effective than intranasal formulations of triptans

b)      Metoclopramide (Reglan)  has been shown to be more effective than prochlorperazine (Compazine) in the treatment of migraines

c)       Triptans are serotonin antagonists

d)      Anti-emetics have no role in the treatment of migraines

Answers and Explanations: Pneumonia Journal Club, Code Review, and Migraines