ABEM Orthopedic & Musculoskeletal Emergencies 1

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

Ottawa Ankle Rules require X-ray if there is bony tenderness at specific malleolar zones OR inability to bear weight (4 steps) both immediately after injury and in the ED.

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

Compartment syndrome is confirmed when pressures are within 30 mmHg of diastolic BP; emergency fasciotomy is the definitive and only treatment.

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

MRI is the preferred modality for occult hip fractures when plain radiographs are negative but clinical suspicion is high, offering high sensitivity and no radiation.

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

Nursemaid's elbow (radial head subluxation) is successfully reduced at the bedside using hyperpronation or supination-flexion without anesthesia.

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

The axillary nerve wraps around the surgical neck of the humerus and is the most commonly injured nerve in anterior shoulder dislocations, causing deltoid weakness and lateral shoulder numbness.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM Orthopedic & Musculoskeletal Emergencies 1