ABEM Orthopedic & Musculoskeletal Emergencies 3

Question 1

A 7-year-old falls from the monkey bars and has distal radius pain. X-ray shows cortical buckling on one side without a complete fracture line. What is the most appropriate treatment?

Accepted Answer

Posterior long-arm splint for 3-4 weeks without reduction

Answer

Open reduction and internal fixation

Answer

Closed reduction under sedation followed by casting

Answer

Short arm cast for 8 weeks

Question 2

A 35-year-old found after lying on a hard surface for 10 hours presents with diffuse muscle pain, dark urine, and creatinine of 3.1 mg/dL. Urine dipstick is 3+ blood with no RBCs on microscopy. What is the most critical initial treatment?

Accepted Answer

Aggressive IV fluid resuscitation with isotonic normal saline

Answer

Furosemide 40 mg IV to promote forced diuresis

Answer

Sodium bicarbonate IV bolus to alkalinize urine

Answer

Urgent hemodialysis initiation

Question 3

A patient arrives in hemorrhagic shock after a high-speed MVA. Pelvis is unstable on examination with an 'open book' pattern on X-ray. Despite 2L of IV crystalloid, BP remains 70/40. What is the most immediate intervention?

Accepted Answer

Apply a pelvic binder and activate massive transfusion protocol

Answer

Immediate exploratory laparotomy

Answer

Bilateral femoral arterial angioembolization

Answer

Emergent CT angiography of the pelvis

Question 4

A 45-year-old new mother presents with radial-sided wrist pain at the base of the thumb that worsens with gripping and pinching. Finkelstein test reproduces her pain. What is the diagnosis?

Accepted Answer

De Quervain's tenosynovitis

Answer

Carpal tunnel syndrome

Answer

Occult scaphoid fracture

Answer

First carpometacarpal joint osteoarthritis

Question 5

A 20-year-old football player receives a direct blow to his shoulder and develops a visible step deformity with elevation of the distal clavicle. Which structures are disrupted in a grade III acromioclavicular separation?

Accepted Answer

Both the acromioclavicular and coracoclavicular ligaments

Answer

Glenohumeral joint capsule and rotator cuff

Answer

The sternoclavicular ligament complex

Answer

The supraspinatus and infraspinatus tendons

Question 6

A 32-year-old sustains a foot injury in a motor vehicle accident. Weight-bearing X-ray reveals a fracture at the base of the second metatarsal with widening between the first and second metatarsals. What injury does this represent?

Accepted Answer

Lisfranc tarsometatarsal fracture-dislocation

Answer

Jones fracture of the fifth metatarsal

Answer

Dancer's fracture (spiral fifth metatarsal)

Answer

Navicular stress fracture

Question 7

A 55-year-old presents with severe low back pain radiating bilaterally to both legs, new urinary retention, and decreased rectal sphincter tone. What is the most appropriate next step?

Accepted Answer

Urgent MRI of the lumbar spine and neurosurgical consultation

Answer

Lumbar X-ray and discharge with muscle relaxants and follow-up

Answer

Epidural steroid injection for nerve root decompression

Answer

NSAIDs, physical therapy referral, and reassurance