EM Case Studies II exam with
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
correct answers ||\\||\\
10. (C) The medial ankle support comprises the deltoid
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
ligaments, which include tibionavicular, ||\\||\\ ||\\||\\ ||\\||\\
anterior tibiotalar, tibiocalcaneal, and posterior tibiotalar ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
parts. The most common mechanism of ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
injury is an external rotational force. The lateral portion of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the ankle is supported by the anterior
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
talofibular, anterior inferior tibiofibular, interosseous, ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
posterior tibiofibular, and the ||\\||\\ ||\\||\\ ||\\||\\
calcaneofibular ligaments. Approximately two-thirds of all ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
ankle injuries are isolated anterior
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
talofibular ligament injuries. About 20% involve both ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
anterior talofibular and calcaneofibular ||\\||\\ ||\\||\\ ||\\||\\
ligament injuries. Less than 5% of the ankle injuries are ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
isolated deltoid ligament sprains. (Ho ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
and Abu-Laban, 2006, pp. 808-820) - correct answers
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
✔✔10. A 16-year-old long-distance runner suffered an ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
external rotation injury to the ankle. Which of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
,following ligaments is most likely injured? ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
(A) anterior talofibular
||\\||\\ ||\\||\\
(B) posterior talofibular
||\\||\\ ||\\||\\
(C) deltoid ||\\||\\
(D) calcaneofibular
||\\||\\
(E) tibiofibular
||\\||\\
24. (D) Flumazenil competitively blocks the effects of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
benzodiazepines on GABAnergic pathway- ||\\||\\ ||\\||\\ ||\\||\\
mediated inhibitors in the central nervous system (CNS). ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Naloxone HCl (Narcan) is a narcotic ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
antagonist. Ketamine is a rapidacting general anesthetic. ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Flutamide is a nonsteroidal, ||\\||\\ ||\\||\\ ||\\||\\
antiandrogenic agent used for prostate carcinoma. (Bosse, ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
2004, pp. 1055-1056) - correct answers ✔✔24. Which of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the following drugs represents the most appropriate
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
antidotal agent for benzodiazepine ||\\||\\ ||\\||\\ ||\\||\\
overdose?
(A) naloxone ||\\||\\
,(B) activated charcoal
||\\||\\ ||\\||\\
(C) ketamine ||\\||\\
(D) flumazenil ||\\||\\
(E) flutamide||\\||\\
36. (E) Glucose is present in cerebrospinal fluid (CSF) and
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
can be detected with a urine glucose
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
dipstick (50 to 80 mg/dL). Injuries in the region of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
nasal bones and nasal process of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
frontal bone may lead to a fracture through the cribiform ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
or ethmoid bones. CSF drainage is most
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
commonly unilateral and may be intermittent, coming in ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
short, rapid gushes, or may present as a ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
steady flow. A clue to a CSF leak can be gained from the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
characteristic "bull'seye" test when the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
fluid is mixed with blood and allowed to dry on a white
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
sheet. This is not helpful after the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
bleeding has stopped. Often, these leaks can seal off ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
spontaneously by having the patient on bed ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
, rest, with the head elevated. Leaks that do not stop
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
require more elaborate evaluation and ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
surgical intervention. (Wilson, 2004, pp. 155-156) - ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
correct answers ✔✔36. A 26-year-old healthy-appearing ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
man presents with rhinorrhea since having a
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
nondisplaced nasal ||\\||\\
fracture 3 weeks prior. According to the patient, his nose ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
has completely healed and feels fine
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
now. He complains of a short gushes of a clear salty
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
tasting liquid out his right nostril several ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
times a day. He states that he can sometimes precipitate
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the drainage by leaning his head forward.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Which test should you run on this liquid? ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
(A) "bull's-eye" test
||\\||\\ ||\\||\\
(B) specific gravity
||\\||\\ ||\\||\\
(C) Gram stain
||\\||\\ ||\\||\\
(D) culture and sensitivity
||\\||\\ ||\\||\\ ||\\||\\
(E) glucose dipstick
||\\||\\ ||\\||\\
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
correct answers ||\\||\\
10. (C) The medial ankle support comprises the deltoid
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
ligaments, which include tibionavicular, ||\\||\\ ||\\||\\ ||\\||\\
anterior tibiotalar, tibiocalcaneal, and posterior tibiotalar ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
parts. The most common mechanism of ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
injury is an external rotational force. The lateral portion of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the ankle is supported by the anterior
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
talofibular, anterior inferior tibiofibular, interosseous, ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
posterior tibiofibular, and the ||\\||\\ ||\\||\\ ||\\||\\
calcaneofibular ligaments. Approximately two-thirds of all ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
ankle injuries are isolated anterior
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
talofibular ligament injuries. About 20% involve both ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
anterior talofibular and calcaneofibular ||\\||\\ ||\\||\\ ||\\||\\
ligament injuries. Less than 5% of the ankle injuries are ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
isolated deltoid ligament sprains. (Ho ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
and Abu-Laban, 2006, pp. 808-820) - correct answers
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
✔✔10. A 16-year-old long-distance runner suffered an ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
external rotation injury to the ankle. Which of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
,following ligaments is most likely injured? ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
(A) anterior talofibular
||\\||\\ ||\\||\\
(B) posterior talofibular
||\\||\\ ||\\||\\
(C) deltoid ||\\||\\
(D) calcaneofibular
||\\||\\
(E) tibiofibular
||\\||\\
24. (D) Flumazenil competitively blocks the effects of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
benzodiazepines on GABAnergic pathway- ||\\||\\ ||\\||\\ ||\\||\\
mediated inhibitors in the central nervous system (CNS). ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Naloxone HCl (Narcan) is a narcotic ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
antagonist. Ketamine is a rapidacting general anesthetic. ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Flutamide is a nonsteroidal, ||\\||\\ ||\\||\\ ||\\||\\
antiandrogenic agent used for prostate carcinoma. (Bosse, ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
2004, pp. 1055-1056) - correct answers ✔✔24. Which of
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the following drugs represents the most appropriate
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
antidotal agent for benzodiazepine ||\\||\\ ||\\||\\ ||\\||\\
overdose?
(A) naloxone ||\\||\\
,(B) activated charcoal
||\\||\\ ||\\||\\
(C) ketamine ||\\||\\
(D) flumazenil ||\\||\\
(E) flutamide||\\||\\
36. (E) Glucose is present in cerebrospinal fluid (CSF) and
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
can be detected with a urine glucose
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
dipstick (50 to 80 mg/dL). Injuries in the region of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
nasal bones and nasal process of the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
frontal bone may lead to a fracture through the cribiform ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
or ethmoid bones. CSF drainage is most
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
commonly unilateral and may be intermittent, coming in ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
short, rapid gushes, or may present as a ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
steady flow. A clue to a CSF leak can be gained from the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
characteristic "bull'seye" test when the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
fluid is mixed with blood and allowed to dry on a white
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
sheet. This is not helpful after the ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
bleeding has stopped. Often, these leaks can seal off ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
spontaneously by having the patient on bed ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
, rest, with the head elevated. Leaks that do not stop
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
require more elaborate evaluation and ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
surgical intervention. (Wilson, 2004, pp. 155-156) - ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
correct answers ✔✔36. A 26-year-old healthy-appearing ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
man presents with rhinorrhea since having a
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
nondisplaced nasal ||\\||\\
fracture 3 weeks prior. According to the patient, his nose ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
has completely healed and feels fine
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
now. He complains of a short gushes of a clear salty
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
tasting liquid out his right nostril several ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
times a day. He states that he can sometimes precipitate
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
the drainage by leaning his head forward.
||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
Which test should you run on this liquid? ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\ ||\\||\\
(A) "bull's-eye" test
||\\||\\ ||\\||\\
(B) specific gravity
||\\||\\ ||\\||\\
(C) Gram stain
||\\||\\ ||\\||\\
(D) culture and sensitivity
||\\||\\ ||\\||\\ ||\\||\\
(E) glucose dipstick
||\\||\\ ||\\||\\
