March 8th Conference Review Questions

Journal Club with Shilpa Patel, Follow-up Rounds, and Intussusception Radiology with Dr. Rubio


1. According to the results from the recent non-inferiority trial comparing the efficacy of intramuscular midazolam with that of intravenous lorazepam for children and adults in status epilepticus treated by paramedics published in the New England Journal of Medicine

a) Intravenous lorazepam is superior to intramuscular midazolam for prehospital seizure cessation in patients with status epilepticus
b) Intramuscular midazolam is superior to intravenous lorazepam for prehospital seizure cessation in patients with status epilepticus
c) Intramuscular midazolam is at least as safe and effective as intravenous lorazepam for prehospital seizure cessation in patients with status epilepticus
d) Intravenous lorazepam is at least as safe and effective as intramuscular midazolam for prehospital seizure cessation in patients with status epilepticus

2. You are reviewing an article comparing the efficacy of IM midazolam to IV lorazepam in patients in status epilepticus treated by paramedics. The results table shows the percentages of patients with seizure termination for each medication with associated 95% confidence intervals. Of the following hypothetical results, which of the following suggest(s) a significant difference between the two groups?

a) IM midazolam: 73.4 (CI 69.3-77.5); IV lorazepam: 67.4 (CI 65.2-72.5)
b) IM midazolam: 73.4 (CI 66.3-78.5); IV lorazepam: 67.4 (CI 63.2-70.9)
c) IM midazolam: 73.4 (CI 69.3-77.5); IV lorazepam: 63.4 (CI 58.9-67.9)
d) Both A and C show a significant difference between the two groups
e) It is not possible to determine if there is a significant difference between the two groups based only on the data presented

3. A 17 year old M with a history of hypertension is brought back from triage with headache, persistent emesis, and a BP of 210/120 and a HR of 70. He has no history of trauma but mom reports that they ran out of his medications some time ago. The patient is lethargic but is protecting his airway. Your first priority is to:

a) Obtain a head CT
b) Decrease the BP by 25% over the next 8 hours using IV medications
c) Decrease the BP by 25% over the next 8 hours using oral medications
d) Normalize the blood pressure as rapidly as possible

4. An 8 month old M is brought in for 24 hours of progressive NBNB emesis without diarrhea or fevers. He became increasingly listless and parents brought him in for evaluation. You obtain an abdominal xray. Which of the following are signs of intussusception on an abdominal radiograph?
a) A donut sign
b) A kidney sign
c) Lateralization of the ileum to the RLQ
d) A double bubble sign

5. An US on this same infant confirms the diagnosis of intussusception and radiology plans to attempt a reduction by enema. Prior to sending the patient to radiology for attempted reduction, all of the following should be done EXCEPT:
a) Surgery should be consulted
b) The patient should be made NPO
c) Morphine should be given just prior to transfer to minimize procedural discomfort
d) Patient should be monitored to ensure adequate fluid resuscitation and hemodynamic stability

Answers here