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Emergency Medicine Trauma Questions With Correct Answers.
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Emergency Medicine Trauma Questions With Correct Answers.
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10/22/24, 10:25 AMEmergency Medicine Trauma
Terms in this set (261)
1/43
,10/22/24, 10:25 AM
Correct Answer ( C )
Explanation:
The patient presents with rupture of the ulnar
collateral ligament (UCL) and requires
immobilization and urgent surgical management.
Injury to the UCL was initially described in Scottish
gamekeepers (hence Gamekeeper's thumb). The
injury was developed through the repetitive
motion of twisting the necks of rabbits. Today, the
injury is most commonly seen in skiers who receive
A 16-year-old girl presents with right thumb
the injury during a fall while holding a ski pole. The
pain after a fall while skiing. Physical
mechanism of injury is forced abduction of the
examination reveals pain and swelling of
thumb resulting in a tear of the UCL near its
the right thumb. X-ray of the thumb is
insertion at the proximal phalanx. Physical
negative. Valgus stress at the
examination reveals swelling and tenderness along
metacarpophalangeal joint results in
the ulnar surface of the thumb and difficulty with
increased pain and deviation of 40
making a pinching motion. Valgus stress of the UCL
degrees. What treatment is indicated?
can differentiate a partial tear from a complete
rupture of the ligament. Stress should be applied
CT scan of the thumb
to the metacarpophalangeal (MCP) joint in full
Sugar tong splint and urgent referral for
extension and at 30 degrees of flexion. If there is
surgical management
more than 35 degrees of joint laxity or 15 degrees
Thumb spica and urgent referral for
of laxity beyond the unaffected thumb, a complete
surgical management
UCL rupture should be suspected. Both partial
Thumb spica for 4 weeks and primary care
tears and complete ruptures should be placed in a
follow up
thumb spica splint. Partial tears typically will
recover completely with immobilization whereas
complete ruptures invariably need surgical repair.
A CT scan of the thumb (A) is not necessary for the
diagnosis of a UCL rupture. Sugar tong splinting
(B) does not immobilize the first MCP or first IP
joints. A thumb spica and follow up with primary
care (D) is appropriate for a partial tear but not for
a complete rupture.
One Step Further Answer: Soft tissue interposition from the adductor aponeurosis associated with a
Question: What is Stener's lesion? ulnar collateral ligament rupture.
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,10/22/24, 10:25 AM
Correct Answer ( D )
Explanation:
The patient presents with minor head trauma and
complaints consistent with a concussion and
should have follow-up arranged with their primary
A 13-year-old boy with no past medical care provider or concussion specialist. A
history presents to urgent care with a concussion is a minor traumatic brain injury (TBI)
headache three days after a closed head that is often seen in MVCs and collision sports
injury. The patient states that he stood up (football, hockey). It is typically caused by a
from kneeling and hit the top of his head rotational injury or an acceleration-deceleration
on a wood cabinet. There was no loss of injury. Patients will present with a number of non-
consciousness or seizure activity. In specific symptoms including headaches, dizziness,
addition to the headache, he complains of confusion, amnesia, difficulty concentrating, and
difficulty concentrating at school and blurry vision but do not have focal neurologic
dizziness. His physical examination is findings. Despite the absence of severe intracranial
unremarkable. What management is injury, patients can have chronic and debilitating
indicated? symptoms from concussions. Neurology referral is
recommended, as patients should have functional
CT scan of the head with contrast testing and tracking of their symptoms for
CT scan of the head without contrast resolution. It is vital to council patients to avoid
MRI of the brain contact sports or activities that increase the risk of
Referral to primary care physician recurrent injury as these patients are at risk for
more severe injury with a second impact.
In the absence of focal neurologic findings,
absence of antiplatelet or anticoagulant use, and
minor trauma, imaging is not needed (A, B, C).
One Step Further Answer: Positron emission tomography (PET) scan.
Question: What imaging modality can show
abnormalities in patients with concussion in
the acute setting?
3/43
, 10/22/24, 10:25 AM
A 55-year-old construction worker Correct Answer ( A )
presents to the ED after a fall from 20 feet Explanation:
while at work. Per EMS, the patient was Trauma patients with a GCS score less than or equal to eight require immediate
confused when they found him with a large airway management. It is suspected that even a single episode of hypoxia in the
hematoma over the right temporal area, patient with severe head trauma leads to a poorer prognosis. This patient should be
swelling of the right maxilla, and endotracheally intubated using etomidate and succinylcholine. Etomidate is an ideal
deformities to the right shoulder and knee. induction agent in the head-trauma patient. Etomidate has been shown to decrease
Appropriate spinal precautions were cerebral oxygen consumption, cerebral blood flow, and intracranial pressure but
initiated prehospital. On arrival at the ED, appears to have minimal effects on cerebral perfusion pressure.
his GCS score is eight with a blood
pressure of 162/96, heart rate of 72, and
oxygen saturation of 100% on a non-
rebreather mask. Which of the following Airway management takes priority in this scenario. Given the patient's GCS score of
statements is correct regarding the eight in the setting of polytrauma, it is recommended to establish a definitive airway.
management of this patient's airway? During endotracheal intubation, the patient's cervical spine should be immobilized to
prevent any further injury to the spinal cord. As long as proper cervical spine
Attempt rapid sequence intubation with precautions are taken, cervical radiographs (B) can be obtained after the patient is
etomidate and succinylcholine stabilized. Achieving this, however, can occur with in-line traction and does not
Cervical spine radiographs should be require immobilization using a hard collar. Although epidural hematoma is a strong
obtained prior to establishing a definitive consideration, it is unsafe to take the patient to head CT (C) without first securing the
airway since the patient's oxygen saturation airway. Consulting neurosurgery for patients with severe head trauma is prudent and
is 100% can occur prior to the return of CT scan results. But the initial priority in such patients
Continue oxygenation via non-rebreather is establishment of a definitive airway. There is a reflexive response to laryngoscopy
face mask and immediately obtain a CT and intubation that increases intracranial pressure, although the precise mechanism is
scan of the brain followed by neurosurgical poorly understood. Intravenous lidocaine (D) is thought to reduce intracranial
consultation pressure and blunt the response to laryngoscopy and intubation. Although recent
Lidocaine administration is contraindicated reports have questioned the clinical benefit, administration of lidocaine during the
due to a paradoxical elevation in pretreatment phase of rapid sequence induction for head injury patients remains a
intracranial pressure component of current ATLS guidelines. The nasotracheal airway (E) should not be
Nasotracheal intubation is an appropriate attempted in patients with midface trauma or potential basilar skull fracture because
alternative to orotracheal airway the tube may inadvertently penetrate the intracranial space.
One Step Further Answer: Approximately 0.5 mEq/L.
Question: How much does succinylcholine
elevate serum potassium concentration?
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