Questions: 29–39
(A) (B) (C) (D) (E)
Sphenoid wing fracture LeFort II fracture Petrous temporal fracture Palatal split Mandibular disruption
34. A 43-year-old man is hit in the face with a baseball bat and presents to the emergency department with massive facial swelling, ecchymosis, and an elongated face. There is mobility of the middle third of the face on digital manipulation of the maxilla. What is the likely diagnosis? (A) (B) (C) (D) (E)
Lambdoid injury Odontoid fracture LeFort III fracture Palatal split Mandibular disruption
35. A 26-year-old man is stabbed in the right intercostal space in the midclavicular line and presents to the emergency department. On examination, subcutaneous emphysema of the right chest wall, absent breath sounds, and a trachea shifted to the left are noted. What is the most likely serious diagnosis? (A) (B) (C) (D) (E)
Pneumothorax Tension pneumothorax Massive hemothorax Hemopneumothorax Chest wall laceration
Questions 36 and 37 36. A 31-year-old man is shot in the back of the left chest, and the bullet exits the left anterior chest. The patient’s blood pressure is 130/90 mm Hg, respiration rate is 28 breaths per minute, and pulse is 110 bpm. A chest x-ray reveals hemothorax. A chest tube is inserted and yields 800 mL of blood; the first and second hour drainage is 200 mL/h and 240 mL/h, respectively. What is the next step in management? (A) Place a second chest tube. (B) Collect the blood for autotransfusion.
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(C) Transfuse and observe drainage for another hour. (D) Insert a Swan-Ganz catheter. (E) Perform a left thoracotomy. 37. In the patient described above the most likely cause of the bleeding in the patient is injury to which of the following? (A) Pulmonary artery (B) Lung parenchyma (C) Internal thoracic (mammary) and/or intercostals arteries (D) Pulmonary vein (E) Left atrium 38. A 60-year-old man crashes his car into a bridge abutment and is found slumped over his steering wheel. In the emergency department, the signs and symptoms of pericardial tamponade are evident. These findings are most likely attributable to which of the following? (A) (B) (C) (D) (E)
Coronary artery laceration Left atrial rupture Right atrial rupture Coronary vein laceration Intrapericardial vena cava injury
39. Following an injury to the shoulder joint, a New York Yankees catcher developed a “catcher’s mitt hand” or shoulder and hand syndrome. There was swelling of the right upper extremity, skin atrophy, and vasomotor instability. He also complained of a burning sensation in the involved extremity. What would be the next step in management? (A) (B) (C) (D) (E)
Immobilization of right arm in cast To avoid physical therapy for 3 months Forceful shoulder joint manipulation Prednisone for 2 weeks in resistant cases Surgical procedure on wrist joint