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

Anatomical snuffbox tenderness after a FOOSH injury warrants presumptive treatment for occult scaphoid fracture with thumb spica splinting and early MRI or repeat X-ray due to avascular necrosis risk.

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

Open fractures require immediate IV antibiotics (cephalosporin plus aminoglycoside for type III) and urgent operative debridement to prevent osteomyelitis and sepsis.

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

Posterior hip dislocation, the most common type, presents with the hip flexed, adducted, and internally rotated — the classic 'dashboard injury' pattern.

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

A positive Thompson test — absence of plantar flexion when the calf is squeezed with the patient prone — confirms complete Achilles tendon rupture.

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

Septic arthritis of the hip requires emergent surgical irrigation and debridement plus antibiotics to prevent articular cartilage destruction and avascular necrosis.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM Orthopedic & Musculoskeletal Emergencies 2