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SAEM Trauma Test | Questions solved 100% Correct
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SAEM Trauma Test | Questionssolved 100% Correct
In a patient with a suspected ruptured globe from penetrating trauma to the eye, all of
the following should be performed EXCEPT:
A. ophthalmology consultation
B. visual acuity assessment
C. administration of broad spectrum antibiotic therapy
D. ascertainment of intraocular pressure via tonometry
E. ascertainment of tetanus status - ✔D. ascertainment of intraocular pressure
via tonometry
Tonometry should not be performed in patients with suspected ruptured globe, as
application of the Tono-Pen pressure to the eye may cause the vitreous humor to exude
from the eye, thereby complicating the injury. Tetanus status is important to check, as
ocular injuries, like skin injuries, may be a portal for tetanus exposure. Broad-spectrum
antibiotic therapy is indicated. Anti-emetic therapy may be helpful in preventing the
elevations in intraocular pressure associated with vomiting. Visual acuity assessment is
important and ophthalmology consultation is critical.
Following a motor vehicle crash, a 25 year old man presents complaining of a painful
right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye. The right
eye protrudes from the orbit and the patient has right eye pain with extraocular
movement. What is the most likely cause of his symptoms?
A. ruptured globe
B. retrobulbar hematoma
C. chemosis
D. hyphema
,E. orbital blow-out fracture - ✔B. retrobulbar hematoma
Traumatic proptosis with impaired extraocular movements is classic for retrobulbar
hematoma. Sequelae include optic nerve ischemia and secondary visual impairment. A
ruptured globe presents with enophthalmos, not proptosis, as vitreous humor leaks out
of the eye. Neither hyphema nor chemosis causes proptosis. Orbital blowout fractures
can cause inferior rectus muscle entrapment and secondary pain with impairment of
extraocular movement. Yet, they do not present with proptosis - unless complicated by
retrobulbar pathology.
Following a brawl at a local bar, a gentleman presents with an impressive right-sided
periorbital ecchymosis. All of the following physical examination findings would
suggest an orbital blowout fracture EXCEPT:
A. right-sided epistaxis
B. proptosis
C. right-sided infraorbital subcutaneous emphysema
D. anesthesia of the right infraorbital region
E. diplopia with upward gaze - ✔B. proptosis
Orbital blowout fractures classically involve the maxillary or ethmoid sinus and
consequently often cause either epistaxis (through the connection of the maxillary sinus
with the nose) or subcutaneous emphysema (through the entry of air from the sinuses
into the subcutaneous tissue). A fracture through the maxillary sinus may extend through
the portal by which the second branch of the trigeminal nerve exits, thus causing
anesthesia of the ipsilateral infraorbital region. If the inferior rectus muscle gets trapped
within the fracture of the inferior orbital wall, patients will be unable to look upward
causing diplopia with upward gaze. Orbital blowout fractures are not typified by
proptosis. In fact, proptosis in the setting of trauma should prompt physicians to suspect
the possibility of a retrobulbar hematoma.
A patient presents with a self-inflicted wound, with resultant loss of vision in the right
eye. With regard to the figure, which of the following statements is most likely true?
[image]
A. Medial canthotomy should be performed immediately.
, B. If ambulance providers contact medical control about a patient with this injury, they
should be directed to replace the globe back into the orbit.
C. Life-threatening hemorrhage is a major risk with this injury.
D. The patient will probably recover visual function.
E. Search for other self-inflicted injuries (or ingestions) is paramount. - ✔E. Search
for other self-inflicted injuries (or ingestions) is paramount.
What is the most common cause of death in Americans aged 20 to 40 years?
A. Cancer
B. Drug overdose
C. AIDS-related illness
D. Trauma
E. Pneumonia - ✔D. Trauma
Following a motor vehicle collision, in which of the following patients is an emergency
department Caesarian section most likely indicated, assuming a fetus at 29-weeks
gestation?
A. Mother with severe head trauma, blood pressure 170/90; fetal heart tones 120 beats
per minute
B. Mother pulseless and apneic for 2 minutes' duration and still in arrest; fetal heart
tones of 100 beats per minute
C. Mother with gunshot wound to abdomen, blood pressure 96/42; fetal heart
tones undetectable
D. Mother with abdominal pain, blood pressure of 80/40; fetal heart tones 100 beats
per minute
E. Mother with vaginal bleeding, blood pressure 118/78; fetal heart tones 80 beats
per minute - ✔B. Mother pulseless and apneic for 2 minutes' duration and still in
arrest; fetal heart tones of 100 beats per minute
Though emergency C-section after maternal death is a rarely indicated procedure,
rapid intervention (within minutes) of maternal demise has resulted in viable births.
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