ABEM Orthopedic & Musculoskeletal Emergencies

Question 1

A 28-year-old male twists his ankle and has tenderness over the lateral malleolus but can bear weight in the ED. According to the Ottawa Ankle Rules, which finding independently mandates an X-ray?

Accepted Answer

Inability to bear weight both immediately after injury and in the ED

Answer

Lateral malleolus tenderness alone

Answer

Mild swelling over the lateral ankle

Answer

Pain with passive inversion of the foot

Question 2

A 25-year-old develops severe forearm pain after a closed forearm fracture. The pain is disproportionate to injury and worsens with passive finger extension. Compartment pressure measures 35 mmHg with a diastolic BP of 60 mmHg. What is the next step?

Accepted Answer

Emergency fasciotomy

Answer

Elevate the extremity and reassess in 2 hours

Answer

Ice, analgesics, and close monitoring

Answer

IV antibiotics and repeat pressure measurement

Question 3

An 80-year-old woman presents with groin pain and inability to bear weight after a fall. Her leg is slightly shortened and externally rotated but plain X-rays are negative. What is the best next imaging step?

Accepted Answer

MRI of the hip

Answer

Discharge with analgesics and follow-up in 1 week

Answer

CT scan of the pelvis

Answer

Technetium bone scan

Question 4

A 3-year-old presents with refusal to use his right arm after being lifted by his hands. The arm hangs with the elbow slightly flexed and forearm pronated. X-rays are normal. What is the most appropriate management?

Accepted Answer

Hyperpronation or supination-flexion reduction technique

Answer

Splint in posterior long-arm splint and obtain MRI

Answer

IV sedation with closed reduction under fluoroscopy

Answer

Orthopedic consultation for casting

Question 5

A 22-year-old sustains an anterior shoulder dislocation during a tackle. Which neurovascular structure is most commonly injured in this dislocation?

Accepted Answer

Axillary nerve

Answer

Radial nerve

Answer

Musculocutaneous nerve

Answer

Brachial artery

Question 6

A patient falls on a flexed, pronated wrist and presents with dorsal wrist pain. X-ray shows a distal radius fracture with volar angulation and dorsal displacement of the carpus. This fracture pattern is called:

Accepted Answer

Smith's fracture

Answer

Colles' fracture

Answer

Barton's fracture

Answer

Chauffeur's fracture

Question 7

A 30-year-old female presents with acute knee injury after pivoting. To test anterior cruciate ligament integrity, which maneuver is performed with the knee at 20-30 degrees of flexion while translating the tibia anteriorly on the femur?

Accepted Answer

Lachman test

Answer

McMurray test

Answer

Valgus stress test

Answer

Patellar apprehension test