Trauma/Emergencies Practice Questions

Q: A 20-year-old male comes into your office two days after falling during a pick up basketball game. The patient states that the lateral aspect of his knee collided with another player's knee. On exam, the patient's right knee appears the same size as his left knee without any swelling or effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity upon varus stress test, but is more lax upon valgus stress test when compared to his left knee. Lachman's test and posterior drawer test both have firm endpoints without laxity. Which of the following structures has this patient injured?

Medial collateral ligament. ***Medial collateral ligament*** - A **valgus stress test** assesses the integrity of the MCL, and increased laxity indicates an injury to this ligament. - The impact to the lateral aspect of the knee against another player would create a **valgus force** on the knee, stressing the MCL. *Anterior cruciate ligament* - The **Lachman's test** assesses the ACL, and a firm endpoint suggests the ACL is intact. - ACL injuries usually present with significant **acute swelling** due to hemarthrosis, which is not noted here. *Lateral collateral ligament* - A **varus stress test** assesses the LCL, and the exam shows no laxity, indicating the LCL is intact. - An injury to the LCL would typically result from a **medial impact** to the knee, creating a varus force. *Posterior cruciate ligament* - The **posterior drawer test** evaluates the PCL, and a firm endpoint indicates no PCL laxity. - PCL injuries often occur from a direct blow to the **anterior tibia**, which is not described. *Medial meniscus* - Meniscus injuries frequently present with **clicking, locking, or catching** sensations in the knee, with pain often localized to the joint line, none of which are mentioned. - While a **valgus force** could damage the medial meniscus, the primary finding of valgus laxity points more directly to an MCL tear.

Q: A 68-year-old man presents to the emergency department with leg pain. He states that the pain started suddenly while he was walking outside. The patient has a past medical history of diabetes, hypertension, obesity, and atrial fibrillation. His temperature is 99.3°F (37.4°C), blood pressure is 152/98 mmHg, pulse is 97/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for a cold and pale left leg. The patient’s sensation is markedly diminished in the left leg when compared to the right, and his muscle strength is 1/5 in his left leg. Which of the following is the best next step in management?

Heparin drip. ***Heparin drip*** - This patient presents with signs and symptoms of **acute limb ischemia** (sudden onset leg pain, cold and pale limb, diminished sensation, and motor weakness) in the setting of **atrial fibrillation**. - Immediate initiation of an **anticoagulant**, such as a heparin drip, is crucial to prevent further clot propagation while definitive treatment is being arranged. *Graded exercise and aspirin* - This management strategy is typically reserved for **chronic peripheral artery disease** (PAD) with intermittent claudication, not acute limb ischemia. - In acute limb ischemia, immediate reperfusion is critical to preserve limb viability, which cannot be achieved with exercise or aspirin alone. *Surgical thrombectomy* - While **surgical thrombectomy** may be the definitive treatment for acute limb ischemia, it is not the *immediate* next step in management. - Anticoagulation should be initiated *before* surgical intervention to stabilize the patient and prevent further thrombosis. *CT angiogram* - A **CT angiogram** is a valuable diagnostic tool to pinpoint the location and extent of the occlusion. - However, in a patient with clear signs of acute limb ischemia, **anticoagulation should not be delayed** for imaging alone. Heparin should be started immediately, and imaging can be performed concurrently if feasible or shortly thereafter. *Tissue plasminogen activator* - **Tissue plasminogen activator (tPA)** is a thrombolytic agent that can be used in some cases of acute limb ischemia, particularly for smaller, more distal thrombi or when surgical options are difficult. - However, its use carries a higher risk of bleeding complications and is generally considered after initial anticoagulation and a thorough assessment, sometimes guided by angiography. It's not typically the *first* step in an emergency presentation like this.

Question 1

A 20-year-old male comes into your office two days after falling during a pick up basketball game. The patient states that the lateral aspect of his knee collided with another player's knee. On exam, the patient's right knee appears the same size as his left knee without any swelling or effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity upon varus stress test, but is more lax upon valgus stress test when compared to his left knee. Lachman's test and posterior drawer test both have firm endpoints without laxity. Which of the following structures has this patient injured?

Accepted Answer

Medial collateral ligament

Answer

Anterior cruciate ligament

Answer

Lateral collateral ligament

Answer

Posterior cruciate ligament

Answer

Medial meniscus

Question 2

A 68-year-old man presents to the emergency department with leg pain. He states that the pain started suddenly while he was walking outside. The patient has a past medical history of diabetes, hypertension, obesity, and atrial fibrillation. His temperature is 99.3°F (37.4°C), blood pressure is 152/98 mmHg, pulse is 97/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for a cold and pale left leg. The patient’s sensation is markedly diminished in the left leg when compared to the right, and his muscle strength is 1/5 in his left leg. Which of the following is the best next step in management?

Accepted Answer

Heparin drip

Answer

Graded exercise and aspirin

Answer

Surgical thrombectomy

Answer

CT angiogram

Answer

Tissue plasminogen activator

Trauma/Emergencies — MCQs

Trauma/Emergencies — MCQs

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