Pass
"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" - ✔✔"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-
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,ray reveals no signs of mediastinitis, but the risk of esophageal perforation
and ultimate mediastinitis prompts endoscopic intervention in this
patient."
"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
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" - ✔✔"D. Immediate
dental consult to avoid abscess formation
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,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."
"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
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, D. Incision and drainage of the septal hematoma followed by nasal
packing
E. Needle aspiration of the septal hematoma" - ✔✔"D. Incision and
drainage of the septal hematoma followed by nasal packing"
"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" - ✔✔"A. Inferior orbital wall fracture
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