SAEM Trauma Comprehensive Exam Questions And Answers.

An 18 year old hockey player is hit in the mouth with a puck, fracturing a maxillary canine tooth. He brings the severed piece of tooth with him. On physical exam, the tooth is fractured halfway between the tip and the gumline. The root of the tooth is still firmly intact. The exposed fracture site has a yellowish tinge without blood. Of the following choices, which is the most appropriate management for this patient? A. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up B. Placement of tooth fragment in saline gauze, outpatient dental follow-up C. No specific treatment required D. Immediate dental consult to avoid abscess formation E. Replace fractured piece and place acrylic splint - correct answer The answer is D. Ellis II dental fracture involves enamel and dentin. The fracture site typically has a yellowish tinge. Ellis III dental fractures are characterized by exposure of pinkish pulp and often blood. These fractures require immediate dental consultation to prevent abscess formation. A 22 year old man is punched in the nose during a fight. He presents to the emergency department with obvious nasal bone deformity. Pressure controls the bleeding. Physical exam reveals no maxillary bone or orbital rim tenderness, intact vision and extraocular movement. The oropharynx and mandible are unremarkable. Nasal inspection reveals a swollen, ecchymotic, tender nasal septum. Which of the following is the most appropriate initial step? A. Incision and drainage of the septal hematoma followed by nasal packing B. Needle aspiration of the septal hematoma C. Plastic surgery consult for immediate reduction of nasal fracture D. Facial CT scan to rule out more serious facial fractures E. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum - correct answer A. Incision and drainage of the septal hematoma followed by nasal packing A 24 year old woman is playing racquetball and sustains a direct blow from the ball to the right eye. She presents to the emergency department complaining of eye pain and double vision. On exam, her right eye does not track properly with upward gaze. This finding suggests which of the following injuries? A. Zygomatic arch fracture B. Ethmoid fracture C. Inferior orbital wall fracture D. Inferior orbital rim fracture E. Superior orbital rim fracture - correct answer C. The patient most likely has an orbital floor fracture with entrapment. A 32 year old man is struck several times in the head with a baseball bat. Upon emergency medical service arrival, he is mildly confused, vomits once, and complains of a severe headache. The emergency medical technicians establish two large-bore IVs. Prior to arrival at the emergency department, he loses consciousness and begins to seize. He is actively seizing when he is brought into the trauma bay. What should be the first step in the management of this patient? A. Administration of mannitol 50 g IV B. Emergency craniotomy C. Rapid sequence intubation using paralytic agent D. Administration of 2 liters NS bolus - correct answer C. Rapid sequence intubation using paralytic agent The airway should be managed as the first priority in this patient. The other maneuvers may be helpful but are secondary to securing an airway and providing oxygenation/ventilation. Airway comes first! A 46 year old man is brought in by EMS after a motor vehicle collision in which he was an unrestrained driver. Although he has no obvious injury to his head or neck, he complains of chest pain and appears very short of breath. His vital signs are: T 99.2 F, BP 85/57, HR 123, RR 36, SpO2 95% on non-rebreather. The CXR demonstrates a tension pneumothorax. Of the following, which is the most appropriate next step in this man's care? A. Performance of a chest CT scan to further delineate the pathology B. Transfusion of 2 units of O-negative packed red blood cells C. Placement of a needle decompression device, followed by repeat CXR D. Placement of a chest tube followed by a chest xray to determine proper placement - correct answer C. Placement of a needle decompression device, followed by repeat CXR This patient needs emergent chest decompression and this is rapidly done by needle thoracostomy. A chest CT may be performed, but only once he is stabilized. A formal chest tube will be placed, but placement may not be rapid enough and he may decompensate in the meantime. Transfusion of blood does nothing to correct the physiology of a tension pneumothorax The most sensitive bedside test for nerve injury in a finger after trauma is: A. light touch B. O'Riain wrinkle test C. pain D. temperature sensation E. two-point discrimination - correct answer E. two-point discrimination Light touch is a good screening test, but two-point discrimination is more sensitive and should be used routinely in evaluating injuries to digits. The O'Riain wrinkle test involves placing the digit in warm water and looking for wrinkling of the digital pulps. Presence of wrinkling indicates the nerve is intact. Which is not part of the Ottawa ankle rules? A. inability to walk 4 steps at the time of the injury B. inability to walk 4 steps in the emergency department C. tenderness over the lateral malleolus D. tenderness over the medial malleolus E. tenderness over the talus - correct answer E. tenderness over the talus The Ottawa ankle rules are a validated (for adults) set of physical exam findings to determine if an ankle X-ray is needed after an injury. If any of the first 4 answers is present or if there is tenderness over the navicular or base of the 5th metatarsal, an X-ray should be obtained. If the correct answer to all questions is no, then an X-ray is not needed. Choose the INCORRECT statement regarding thoracentesis from the anterior approach (needle decompression): A. The recommended insertion site is the second intercostal space, midaxillary line. B. An upright chest X-ray should always be performed following a thoracentesis to confirm the successful relief of a tension pneumothorax and the absence of hemothorax or other complications. C. If a tension pneumothorax is confirmed via needle decompression, then a thoracostomy tube should be placed as soon as possible. D. A 14- to 20-gauge needle is inserted perpendicularly over the superior edge of the rib. E. After the needle is inserted into the pleural space, a rush of air confirms the presence of a tension pneumothorax. - correct answer A. The recommended insertion site is the second intercostal space, midaxillary