Question 1
"The chest X-ray in the Figure was taken in an intoxicated patient who is conversant, but
an unreliable historian. The X-ray findings are best described as indicating:
[image]
A. Esophageal foreign body
B. Intratracheal foreign body
C. mediastinitis from esophageal perforation
D. normal chest"
CORRECT ANSWER
"A. Esophageal foreign body
The answer is A. The film reveals a classic appearance of a round foreign body (in this case, a
pull-top from a beer can) in the esophagus. The foreign body appears to lie outside the
tracheal shadow. There is no sign of mediastinal air (which would be expected with
penetrating trauma). The X-ray reveals no signs of mediastinitis, but the risk of esophageal
perforation and ultimate mediastinitis prompts endoscopic intervention in this patient."
Question 2
"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. No specific treatment required
B. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up
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@THE STUDY VAULT
,C. Placement of tooth fragment in saline gauze, outpatient dental follow-up
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint"
CORRECT ANSWER
"D. Immediate dental consult to avoid abscess formation
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."
Question 3
"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. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum
B. Plastic surgery consult for immediate reduction of nasal fracture
C. Facial CT scan to rule out more serious facial fractures
D. Incision and drainage of the septal hematoma followed by nasal packing
E. Needle aspiration of the septal hematoma"
CORRECT ANSWER
"D. Incision and drainage of the septal hematoma followed by nasal packing"
Question 4
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@THE STUDY VAULT
,"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. Inferior orbital wall fracture
B. Superior orbital rim fracture
C. Ethmoid fracture
D. Zygomatic arch fracture
E. Inferior orbital rim fracture"
CORRECT ANSWER
"A. Inferior orbital wall fracture
The answer is A. The patient most likely has an orbital floor fracture with entrapment."
Question 5
"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 phenytoin 1000mg IV
B. Administration of mannitol 50 g IV
C. Rapid sequence intubation using paralytic agent
D. Emergency craniotomy
E. Administration of 2 liters NS bolus"
CORRECT ANSWER
"C. Rapid sequence intubation using paralytic agent
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@THE STUDY VAULT
, The answer is C. 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!"
Question 6
"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. Placement of a chest tube followed by a chest xray to determine proper placement
B. Transfusion of 2 units of O-negative packed red blood cells
C. Performance of a chest CT scan to further delineate the pathology
D. Placement of a needle decompression device, followed by repeat CXR"
CORRECT ANSWER
"D. 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"
Question 7
"The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
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@THE STUDY VAULT
"The chest X-ray in the Figure was taken in an intoxicated patient who is conversant, but
an unreliable historian. The X-ray findings are best described as indicating:
[image]
A. Esophageal foreign body
B. Intratracheal foreign body
C. mediastinitis from esophageal perforation
D. normal chest"
CORRECT ANSWER
"A. Esophageal foreign body
The answer is A. The film reveals a classic appearance of a round foreign body (in this case, a
pull-top from a beer can) in the esophagus. The foreign body appears to lie outside the
tracheal shadow. There is no sign of mediastinal air (which would be expected with
penetrating trauma). The X-ray reveals no signs of mediastinitis, but the risk of esophageal
perforation and ultimate mediastinitis prompts endoscopic intervention in this patient."
Question 2
"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. No specific treatment required
B. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up
1
@THE STUDY VAULT
,C. Placement of tooth fragment in saline gauze, outpatient dental follow-up
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint"
CORRECT ANSWER
"D. Immediate dental consult to avoid abscess formation
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."
Question 3
"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. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum
B. Plastic surgery consult for immediate reduction of nasal fracture
C. Facial CT scan to rule out more serious facial fractures
D. Incision and drainage of the septal hematoma followed by nasal packing
E. Needle aspiration of the septal hematoma"
CORRECT ANSWER
"D. Incision and drainage of the septal hematoma followed by nasal packing"
Question 4
2
@THE STUDY VAULT
,"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. Inferior orbital wall fracture
B. Superior orbital rim fracture
C. Ethmoid fracture
D. Zygomatic arch fracture
E. Inferior orbital rim fracture"
CORRECT ANSWER
"A. Inferior orbital wall fracture
The answer is A. The patient most likely has an orbital floor fracture with entrapment."
Question 5
"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 phenytoin 1000mg IV
B. Administration of mannitol 50 g IV
C. Rapid sequence intubation using paralytic agent
D. Emergency craniotomy
E. Administration of 2 liters NS bolus"
CORRECT ANSWER
"C. Rapid sequence intubation using paralytic agent
3
@THE STUDY VAULT
, The answer is C. 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!"
Question 6
"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. Placement of a chest tube followed by a chest xray to determine proper placement
B. Transfusion of 2 units of O-negative packed red blood cells
C. Performance of a chest CT scan to further delineate the pathology
D. Placement of a needle decompression device, followed by repeat CXR"
CORRECT ANSWER
"D. 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"
Question 7
"The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
4
@THE STUDY VAULT
