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1. A 47-year-old man presents to the ED complaining of knee pain after slipping on ice on his way to On examination, you note significant swelling to his knee and palpate a large effusion. The patient has limited range of motion because of the swelling. You perform a palliative arthro- centesis and note blood and fat globules in the syringe. Which of the fol- lowing findings is the presence of fat globules most suggestive of?
- ACL tear
- PCL tear
- Medial meniscus tear
- Vascular injury
2. A 76-year-old woman is brought into the ED complaining of hip pain after a motor vehicle She states that her knee slammed into the dashboard after her car struck another vehicle. On examination you note her right leg appears shortened, adducted, internally rotated, and flexed. She has no other injuries. The radiograph of her hip confirms your diag- nosis of a hip dislocation. Which of the following statements regarding this type of injury is true?
- The most common presentation of this injury is an abducted, externally rotated, and flexed lower extremity.
- This type of injury accounts for 5% to 10% of all hip dislocations.
- The injury is commonly caused by a direct force applied to a flexed knee.
- The most common complication is injury to the femoral artery.
- The femoral nerve is almost always injured in this type of dislocation.
3. A 33-year-old carpenter was working on a construction project to build a new When using a high-pressure paint gun, he inadver- tently injected his left index finger. On arrival to the ED, he complains of intense hand pain. On examination, you note a 2-mm wound over the second proximal phalange. He has full range of motion and brisk capillary refill. Radiographs of the finger show soft tissue swelling, a small amount of subcutaneous air, but no fracture. His tetanus is up to date. Which of the following is the most appropriate disposition for this patient?
- Place the hand in a radial gutter splint and have the patient follow up with an orthopedic surgeon in 1 week.
- Discharge home with pain medication and have the patient return for repeat radiographs in 1 week.
- Order a CT scan of the finger to confirm that there is no occult fracture before discharging the patient home.
- Place the hand in a radial gutter splint, prescribe a 10-day course of antibiotics, and have the patient follow up with an orthopedic surgeon in 1 week.
- Place the hand in a radial gutter splint, administer broad-spectrum antibiotics, and admit the orthopedic service for operative debridement.
4. A 29-year-old man is 10 ft up on a ladder, painting his barn ceiling when he loses his balance and falls off the ladder, landing on both of his feet and then falling to the He is brought to the ED by emergency medical services (EMS). On examination there are no obvious deformities, but you note swelling, tenderness, and ecchymosis of the right hindfoot. He has full range of motion at the ankle, knee, and hip. There is mild ten- derness over his lumbar spine. Hs neurovascular status is normal. Radio- graphs confirm the diagnosis. Which of the following statements regarding this type of injury is true?
- This injury is the second most commonly fractured tarsal bone.
- 10% are associated with compression fractures of the dorsolumbar spine.
- 90% are bilateral.
- The mechanism of injury is usually secondary to rotational force at the subtalar joint.
- These fractures require operative repair to avoid gait defects.
5. A 39-year-old woman is brought to the ED by EMS on a backboard and cervical collar after being involved in a motor vehicle The primary survey is unremarkable. However, the secondary survey reveals a deformity of the right arm involving the upper arm and elbow. Which of the following associations are paired incorrectly?
- Olecranon fracture and ulnar nerve injury
- Posterior elbow dislocation and ulnar and median nerve injury
- Anterior elbow dislocation and brachial artery injury
- Supracondylar fracture and brachial artery and median nerve injury
- Humeral shaft fracture and axillary nerve injury
6. A 31-year-old man is riding his mountain bicycle down a steep hill when he hits a rock in the path and is thrown off the In the ED, the individual complains only of left arm pain. Your primary survey is unremarkable. After administering medication for pain control, you send the patient for a radiograph of his arm. Which of the following injuries is consistent with this patient’s radiograph as seen below?
- Monteggia fracture
- Galeazzi fracture
- Nightstick fracture
- Colles fracture
- Smith fracture