ABEM Orthopedic & Musculoskeletal Emergencies 2

Question 1

A 30-year-old falls on an outstretched hand and has anatomical snuffbox tenderness. Initial X-rays are negative. What is the most appropriate management?

Accepted Answer

Thumb spica splint with MRI or repeat X-ray in 1-2 weeks

Answer

Discharge with wrist splint and routine follow-up in 2 weeks

Answer

CT scan of the wrist immediately

Answer

Apply cast for 6 weeks without further imaging

Question 2

A patient presents with a Gustilo type IIIB open tibia fracture with significant soft tissue loss. After hemorrhage control and wound assessment, what is the highest priority in the ED?

Accepted Answer

Immediate IV antibiotics and urgent surgical debridement in the OR

Answer

Wound irrigation with saline followed by primary closure in the ED

Answer

Splinting and outpatient orthopedic follow-up within 24 hours

Answer

ORIF in the ED procedure room

Question 3

A 35-year-old is restrained in a head-on collision. He presents with his right hip in flexion, adduction, and internal rotation with severe pain. What is the most likely diagnosis?

Accepted Answer

Posterior hip dislocation

Answer

Anterior hip dislocation

Answer

Intertrochanteric hip fracture

Answer

Central acetabular fracture-dislocation

Question 4

A 40-year-old squash player hears a 'pop' and feels as if he was kicked in the back of his leg. He cannot plantar flex against resistance. Which test confirms the diagnosis?

Accepted Answer

Thompson test (calf squeeze test)

Answer

Anterior drawer test of the ankle

Answer

Tinel sign at the heel

Answer

Peroneal provocation test

Question 5

A 7-year-old presents with 3 days of fever, hip pain, and refusal to bear weight. WBC is 18,500, ESR 60, CRP 4.8 mg/dL, and temperature 38.9°C — meeting all 4 Kocher criteria. Ultrasound shows an effusion. What is the definitive treatment?

Accepted Answer

Emergent surgical joint irrigation and debridement

Answer

IV antibiotics alone for 6 weeks

Answer

Joint aspiration alone with IV antibiotics

Answer

NSAIDs and bed rest with repeat labs in 48 hours

Question 6

A patient sustains a closed mid-shaft femur fracture after a motor vehicle collision. Approximately how much blood can accumulate in the thigh from this injury?

Accepted Answer

1000-1500 mL

Answer

250-500 mL

Answer

500-750 mL

Answer

2500-3000 mL

Question 7

A 25-year-old jams her finger and cannot actively extend the distal interphalangeal (DIP) joint; there is a slight flexion deformity. X-ray shows no bony avulsion. What is the correct diagnosis and treatment?

Accepted Answer

Mallet finger; continuous DIP extension splinting for 6-8 weeks

Answer

Boutonniere deformity; PIP extension splinting

Answer

Jersey finger; urgent surgical tendon repair

Answer

Swan neck deformity; hand therapy referral