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1.A 25-year-old man presents to the emergency department (ED) with a right forearm laceration that he sustained from a piece of glass during a bar fight. He complains of pain at the laceration site but denies a foreign body sensation. On examination, the laceration is superficial and 4 cm The patient demonstrates intact strength and sensation distally. Which of the following statements regarding imaging this patient is true?
- Imaging can be omitted because he does not have a foreign body sensation.
- Imaging is not indicated because retained glass does not cause an inflammatory reaction.
- Plain film is the next best step in the management of this patient.
- Computed tomographic (CT) scan is the most commonly used modality to rule out a foreign body.
- Plain film cannot rule out bone, teeth, or glass in soft tissue.
2. A 30-year-old woman presents to the ED with a left hand She reports cutting herself while attempting to slice a bagel. She has a superficial 2-cm laceration over the left thenar eminence. No deeper struc- tures are involved. What is the best way to clean the wound?
- Punch holes in a normal saline bag or bottle and irrigate the wound.
- Use a high-pressure syringe and irrigate with water.
- Wound cleaning is unnecessary because wound was sustained from a clean knife.
- Soak her hand in normal saline for 30 minutes.
- Apply povidone-iodine to the wound.
3. A 40-year-old man presents to the ED with a left foot puncture wound from stepping on a rusty His last tetanus vaccine was during childhood, which resulted in a severe allergic reaction and a prolonged hospital stay. Which of the following is true regarding tetanus immuniza- tion in this patient?
- Give tetanus toxoid.
- Give tetanus immunoglobulin.
- Give tetanus immunoglobulin and toxoid.
- Give neither tetanus toxoid nor immunoglobulin because he has had an allergic reaction in the past.
- Give tetanus toxoid and immunoglobulin with diphenhydramine.
4. A 5-year-old boy is brought to the ED by his mom for a forehead She reports that he slipped on ice and hit his head. There was no loss of consciousness. The child is alert and active. He has a 3-cm-forehead laceration that crosses the hairline. What is the most appropriate method of wound closure in this patient?
- Shave the hair surrounding the laceration and close with interrupted sutures.
- Shave the hair surrounding the laceration and close with topical skin adhesive (Dermabond).
- Close with staples.
- Close with Steri-Strips.
- Close with interrupted sutures.
5. A 12-year-old girl presents to the ED with a left index finger lacera- tion. She sustained the injury when her friend accidentally closed the car door on her She has a semicircular laceration distal to the distal interphalangeal (DIP) joint on the volar surface of the left second digit. Sensation distal to the laceration is intact. Range of motion at the DIP joint is intact. The patient hopes to be a hand model in the future and is extremely anxious about the cosmetic result. Which of the following is the best method to provide anesthesia in this patient?
- Application of a tourniquet to control bleeding and irrigation of the wound with 3 cc of lidocaine
- Local infiltration through the wound margins with 3 cc of lidocaine
- Local infiltration through the wound margins with 3 cc of lidocaine with epinephrine
- A digital block at the base of the proximal phalanx with 3 cc of lidocaine
- A digital block at the base of the proximal phalanx with 3 cc of lidocaine with epinephrine
6. An 18-year-old woman presents to the ED with a lower lip laceration secondary to a The patient reports she fell forward after her heel caught in a storm drain. In addition to small facial abrasions, she has a 3-cm-deep laceration on the inner aspect of the lower lip. You plan to close the lacera- tion to control bleeding and prevent food impaction. Which of the follow- ing suture material is the best choice in this patient?
- 2-0 nylon
- 6-0 nylon
- 3-0 monofilament absorbable
- 1-0 absorbable chromic gut
- 5-0 absorbable chromic gut
7. A 50-year-old man presents to the ED for suture When he was on vacation in Jamaica 2 days ago, he sustained a 4-cm right calf lacer- ation from a piece of glass. At that time, the laceration was irrigated, radio- graphed to rule out a foreign body, and repaired. Currently, there is good wound edge approximation and no surrounding erythema or discharge from the wound. What is the next best step in management?
- Have the patient return in 3 days for suture removal.
- Have the patient return in 8 days for suture removal.
- Have the patient return in 14 days for suture removal.
- Remove the sutures.
- Remove the sutures then replace them to prevent infection.
8. A 27-year-old man presents to the ED with the laceration shown below after an There are no dental fractures and his tetanus immunization is up to date. What are the most appropriate next steps in management?
- Infraorbital nerve block and then approximation of the vermilion border
- Infiltration of local anesthesia into the lip and then approximation of the vermil- ion border
- Infraorbital nerve block and closure of mucosal defects before the approxima- tion of the vermilion border
- Infiltration of the lip with local anesthesia, closure of dermis and mucosal defects, and then approximation of the vermilion border
- Closure with a commercially available tissue adhesive and Steri-Strips to avoid distorting tissue architecture
9. A 44-year-old woman presents to the ED with a deep puncture wound to her left forearm from a dog The dog is appropriately vacci- nated. Which of the following statements regarding management of animal bite wounds is true?
- Infection after dog and cat bites is rare.
- Irrigate the wound thoroughly and place deep sutures to prevent infection.
- Delayed primary closure can be used for bite wounds.
- Dog-bite infections are most commonly secondary to Pasteurella multocida.
- Clindamycin is the most commonly used antibiotic for dog bites.
10. A 23-year-old man presents to the ED complaining of a wound to his left lower He states he was pulling branches out of a flooded creek in his backyard when he punctured his left calf. He states that his legs were in the water when the wound occurred. On examination, the puncture wound is 1 cm in diameter, several centimeters deep, and dem- onstrates surrounding erythema. After irrigating the wound, you discover a splinter within the wound. What is the most appropriate next step in management?
- Radiograph to map the exact location of the foreign body.
- Close the wound with 4-0 nylon.
- Dress the wound with a sterile bandage and treat with a fluoroquinolone.
- Remove the splinter.
- Remove the splinter, close the wound, and treat with fluoroquinolone.
11. A 21-year-old woman presents to the ED with a superficial 2-cm mid-forehead laceration sustained from a You irrigate and close the wound. The patient is an aspiring actress and concerned about her long- term cosmetic outcome. She requests detailed wound care instructions. Which of the following statements would be an appropriate wound care instruction to give?
- Avoid direct sun exposure while the wound is healing.
- The wound should not be washed until sutures are removed.
- Sutures should be removed in 7 to 10 days.
- Appearance of the scar at suture removal will be the final cosmetic outcome.
- Good suturing technique and meticulous wound care guarantee no scar formation.
12. A 17-year-old adolescent presents to the ED with a lip He sustained the laceration during an altercation. On examination, he has a horizontal, 2-cm laceration of the right lower lip crossing the midline. There is significant swelling of the lower lip. The attending asks you, the intern, to perform a mental block for anesthesia. Which of the following statements regarding mental blocks is correct?
- A mental block is performed by injecting lidocaine into the mental nerve foramen.
- The patient requires a right-sided mental block.
- A mental block is not appropriate in this patient because it will lead to worsened swelling of the lower lip swelling.
- A mental block anesthetizes the mental nerve, which innervates the lower lip.
- A mental block is performed with a 3-cc syringe attached to an 18-gauge needle.
13. A 9-year-old girl is brought to the ED by her parents after sustain- ing a forehead Her dad reports that the patient hit her forehead against a doorknob. On examination, the patient is cooperative but anx- ious about the upcoming anesthetic injection. She has a 0.5-cm laceration on the mid-forehead with clean edges. Her parents inquire about “skin glue” they heard about on TV. Which of the following statements is true regarding cyanoacrylate tissue adhesives?
- It cannot be applied to mucous membranes and areas with thick hair.
- Tissue adhesives have a higher rate of infection and tissue dehiscence than sutures.
- Tissue adhesives are best suited for forehead lacerations between 5 and 10 cm in length.
- Tissue adhesives are applied inside the wound to pull skin edges together.
- Tissue adhesives must be covered with topical antibiotics and bandages to pre- vent sloughing.
14. A 45-year-old woman presents to the ED with multiple facial lacera- tions. She was sitting by her window when the neighbor’s kid hit a baseball through her The shattered glass caused multiple superficial lac- erations. The most notable laceration is 1 cm on the right eyelid. You rule out the presence of a foreign body and give her a tetanus shot. Which of the following statements regarding eyelid trauma is correct?
- A slit-lamp examination is unnecessary because it does not help evaluate the eyelid.
- Tissue adhesives can be used to close eyelid laceration because they are usually small.
- Lacerations causing ptosis require ophthalmology consultation.
- Ptosis after an eyelid laceration is common.
- A lacrimal duct injury should be suspected in a laceration to the lateral canthus.
15. A 30-year-old chef presents to the ED with a complete fingertip She says her knife slipped while chopping vegetables. She brought the amputated pulp in a plastic bag. On examination, the patient has a clean, 5-mm-diameter dermal slice on the distal volar tip of the sec- ond digit. There is profuse nonpulsatile bleeding. There is no trauma to the DIP joint, proximal interphalangeal (PIP) joint, or the nail. Her most recent tetanus booster was 1 year ago. Which of the following is the most appropriate next step in management?
- Consult hand surgery for replantation of the pulp in the operating room.
- Irrigate the hand and replant distal tip in the ED as soon as possible.
- Perform a digital block with lidocaine and epinephrine to control bleeding.
- Immediately place the amputated tip on ice to prevent cell death.
- Discharge the patient with a pressure dressing and splint after the wound is irrigated and the bleeding is controlled.