Question 1
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.
Question 2
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
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,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
Question 3
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.
Question 4
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
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, 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!
Question 5
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
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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.
Question 2
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
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,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
Question 3
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.
Question 4
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
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, 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!
Question 5
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
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