FACEM Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: A 55-year-old diabetic presents with severe flank pain radiating to the groin, nausea, and microscopic hematuria. Which investigation is most appropriate for diagnosis?
- Abdominal X-ray (KUB)
- Renal ultrasound
- Non-contrast CT abdomen/pelvis (Correct answer)
- Intravenous pyelogram
Correct answer: Non-contrast CT abdomen/pelvis
Non-contrast CT of the abdomen and pelvis is the gold standard for diagnosing urolithiasis, detecting >95% of stones regardless of composition.
Question 2: During secondary survey of a multi-trauma patient, you identify a Chance fracture on imaging. Which associated injury must be urgently evaluated?
- Splenic laceration
- Hollow viscus injury (Correct answer)
- Aortic injury
- Diaphragmatic rupture
Correct answer: Hollow viscus injury
Chance fractures (flexion-distraction injuries of the thoracolumbar spine) are associated with hollow viscus injuries in up to 50% of cases.
Question 3: A 72-year-old woman on warfarin presents with headache after a minor fall. Her GCS is 15 and neuro exam is normal. Which statement about CT head imaging is most accurate?
- CT is unnecessary given normal neuro exam
- CT should be delayed until INR is known
- CT should be performed given anticoagulation and head trauma (Correct answer)
- CT is only indicated if GCS <13
Correct answer: CT should be performed given anticoagulation and head trauma
Anticoagulation is an independent indication for CT head after any head trauma due to the significantly elevated risk of intracranial hemorrhage.
Question 4: Which scoring tool is used to risk-stratify patients presenting with upper gastrointestinal bleeding in the emergency department?
- CURB-65
- Glasgow-Blatchford Score (Correct answer)
- GRACE Score
- TIMI Score
Correct answer: Glasgow-Blatchford Score
The Glasgow-Blatchford Score uses clinical and biochemical variables to identify patients with UGIB who require endoscopic intervention or blood transfusion.
Question 5: A 28-year-old pregnant woman at 32 weeks presents with headache, blurred vision, and BP 160/110 mmHg. Which finding on urinalysis would confirm a diagnosis of preeclampsia?
- Glucosuria
- Proteinuria ≥300 mg/24h or protein:creatinine ratio ≥0.3 (Correct answer)
- Bacteriuria
- Ketonuria
Correct answer: Proteinuria ≥300 mg/24h or protein:creatinine ratio ≥0.3
Preeclampsia is defined as new-onset hypertension (≥140/90) after 20 weeks' gestation with significant proteinuria (≥300 mg/24h) or end-organ damage.
Question 6: When using the Canadian C-Spine Rule to clear the cervical spine clinically, which factor makes radiographic imaging mandatory?
- Age over 50 years (Correct answer)
- Neck pain only with movement
- Ability to actively rotate neck 45° bilaterally
- Simple rear-end motor vehicle collision
Correct answer: Age over 50 years
The Canadian C-Spine Rule mandates imaging for high-risk factors including age ≥65, dangerous mechanism, or paresthesias in extremities.
Question 7: A patient presents with sudden onset of the 'worst headache of their life.' CT head is negative. What is the next essential investigation?
- MRI brain
- CT angiography
- Lumbar puncture for xanthochromia (Correct answer)
- EEG
Correct answer: Lumbar puncture for xanthochromia
Lumbar puncture looking for xanthochromia should be performed when subarachnoid hemorrhage is suspected but CT is negative, as CT sensitivity decreases after 6 hours.
FACEM Patient Assessment and Evaluation 3
A 55-year-old diabetic presents with severe flank pain radiating to the groin, nausea, and microscopic hematuria.
Which investigation is most appropriate for diagnosis?