Emergency Medicine

Question 1

What is Salter
harris fracture
classification?

Answer 1

Type One - Straight through the growth
plate
Type Two - Through and above the
growth plate (into metaphysis)
Type Three - Through and below the
growth plate (into the epiphysis)
Type Four - Above through and below the
growth plate
Type Five - Compression fracture of the
growth plate

Question 2

Nerve and artery
most likely to be
injured in
supracondylar
fracture?

Answer 2

Brachial
artery and
median nerve

Question 3

What is a
monteggia
injury?

Answer 3

Ulna fracture at
the elbow with
radial head
dislocation

Question 4

Clinical Signs
of a scaphoid
fracture?

Answer 4

Pain on dorsiflexion of
wrist
Tenderness in snuff box
Pain on gripping
Normal xray

Question 5

Treatment
of scaphoid
fracture?

Answer 5

Short arm
cast with
thumb spica

Question 6

What is the sensory and motor innervation of the radial nerve?

Answer 6

Sensory – Innervates most of the skin of the posterior forearm, the lateral aspect of the dorsum of the hand, and the dorsal surface of the lateral three and a half digits.
Motor – Innervates the triceps brachii and the extensor muscles in the forearm.

Question 7

Sensory and motor innervation of the axillary nerve?

Answer 7

Sensory functions: Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental badge area’).
Motor functions: Innervates the teres minor and deltoid muscles.

Question 8

Sensory and motor innervation of the musculocutaneous nerve?

Answer 8

Motor functions – muscles in the anterior compartment of the arm (coracobrachialis, biceps brachii and the brachialis).
Sensory functions – gives rise to the lateral cutaneous nerve of forearm, which innervates the lateral aspect of the forearm.

Question 9

Sensory and motor innervation of the ulna nerve?

Answer 9

Motor functions:
Two muscles of the anterior forearm – flexor carpi ulnaris and medial half of flexor digitorum profundus
Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals)
Sensory functions: Medial one and half fingers and the associated palm area.

Question 10

Sensory and motor innervation of the median nerve?

Answer 10

Motor functions: Innervates the flexor and pronator muscles in the anterior compartment of the forearm (except the flexor carpi ulnaris and part of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand.
Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the lateral aspect of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand.

Question 11

What is the
timeline of
ossification centres
in the elbow?

Answer 11

Capitellum (1)
Radial head (3)
Internal epicondyle (5)
Trochlea (7)
Olecranon (9)
External epicondyle (11)

Question 12

What the primary
locations of
ewings
sarcomas?

Answer 12

Lateral ribs,
iliac bones,
femur, fibula,
tibia

Question 13

Where are
chondrosarcomas
typically found?

Answer 13

Costal cartilages
between distal
rib end and
sternum

Question 14

Appearance of
osteosarcoma
on xray?

Answer 14

Starburst
sclerotic
lesion

Question 15

What would a
small translucent
hole in a bone on
xray represent?

Answer 15

Osteoid
osteoma

Question 16

What is the dose
of adrenaline for
anaphylaxis vs
cardiac arrest?

Answer 16

Anaphylaxis = 10mcg/kg
of 1:1000 (1mg/mL =
0.01mL/kg)
Cardiac arrest =
10mcg/kg of 1:10,000
(1mg/10mL = 0.1ml/kg)

Question 17

If a child came in shocked
and ECG rhythm showed
polymorphic ventricular
ectopics what would you
be thinking? What should
you not give? What is
used to treat?

Answer 17

Catecholaminergic polymorphic
ventricular tachycardia is an inherited
channelopathy where they will have
episoic palpitations, syncope or cardiac
arrest. Precipitated by exercise or acute
emotion.
Don’t give adrenaline as this will worsen
the ectopics.

Question 18

A child comes in after a MVA, they examine well but have 60 microscopic RCC seen on urinalysis, what should you do?

Answer 18

Abdominal CT scan, children are more vulnerable to significant renal injury. Haematuria of >30RCC warrants further investigation.

Question 19

Describe the differences in presentation between a child with an extradural haemorrhage vs a subdural haemorrhage?

Answer 19

Extradural - Lucid interval, followed by ongoing severe headache and deterioration. Arterial bleed.
Subdural - Gradual deterioration LOC, venous subdural bridging veins.

Question 20

What percentage of children experience abdominal injuries after fatal polytrauma?

Answer 20

20%, note it is the most unrecognised cause of fatal injury

Question 21

How does neurogenic shock present? What treatment would you start?

Answer 21

Bradycardia, hypotension, vasodilation (warm)
Fluids, inotropes, Atropine, Glycopyyronium bromide

Question 22

2 year old boy accidentally hit in the eye by a cricket bat. He has a pulsating proptosis of his eye and is unable to look down. What is the most likely injury?

Answer 22

Superior wall orbital fracture

Question 23

If you saw tear drop sign on a CT scan of the facial bones what injury would you suspect?

Answer 23

Inferior wall orbital fracture

Question 24

Describe the findings in someone with a methamphetamine overdose.

Answer 24

Tachycardia, hypertension, tachypnoea, hyperthermic, mydriasis reactive to light, hyperactive bowel sounds, flushed and sweating, agitation

Question 25

Describe anticholinergic toxidrome. Examples of medication overdoses that cause this.

Answer 25

Mad as a hatter, blind as a bat (mydriasis - not responsive to light), read as a beat (flushed), hot as a hare (hyperthermic), dry as a bone, bowel and bladder loose their tone (constipation, urinary retention), tachycardia, picking behaviours.
Tricyclic antidepressants, Antihistamines

Question 26

Describe serotonin syndrome.

Answer 26

Agitation, diaphoresis, tachycardia, hypertension, hyperthermic, sweating, hypertonia, hypereflexia with clonus, mydriasis

Question 27

Differences between neuroleptic malignant syndrome and serotonin syndrome.

Answer 27

Serotonin syndrome - abrupt onset, hyperreflexia, myoclonus and tremor, mydriasis
Neuroleptic malignant syndrome - Gradual onset, diffuse rigidity, decreased reflexes, normal pupils

Question 28

Describe cholinergic syndrome and treatment.

Answer 28

Bradycardia, confused, salivation, lacrimation, urination, GI upset - diarrhoea, vomiting, pin point pupils
Atropine

Question 29

Treatment for neuroleptic malignant syndrome.

Answer 29

Bromocriptine, amantadine, dantrolene

Question 30

What toxin overdose can cause prolonged QRS interval with hypotension and tachycardia? What is the management?

Answer 30

Tricyclic antidepressant (can also cause anticholinergic syndrome)
Sodium bicarbonate

Question 31

Antidote for benzodiazepines?
Antidote for iron?
Antidote for calcium channel blockers?

Answer 31

Flumazenil
Desferrioxamine
High dose insulin euglycaemic therapy

Question 32

What do you give in colchicine ingestion?

Answer 32

Charcoal as there is no antidote

Question 33

Nausea, vomiting, respiratory alkalosis, anion gap metabolic acidosis, tinnitus, fever, agitation/confusion or coma. What is the likely ingested agent?

Answer 33

Salicylate
Treatment: Sodium bicarbonate to raise urine pH

Question 34

What is the most common side effect associated with ketamine?

Answer 34

Laryngospasm
Also bronchodilator, tachycardia, hypertension, nightmares, hyper salivation

Question 35

Which sedation medication causes chest wall rigidity?

Answer 35

Fentanyl

Question 36

Antagonist for midazolam

Answer 36

Flumazenil

Question 37

When is nitrous oxide contraindicated?

Answer 37

 Gas filled space
 Pneumothorax
 Bowel obstruction
 Severe head injuries (potential for pneumocranium)
 Intoxication/depressed conscious level
 Pregnancy
 Requiring >50% O2

Question 38

If there is a friction rub in someone with pericarditis what will you not see on ECG?

Answer 38

You will NOT see decrease in precordial voltages as there will not be significant pericardial fluid accumulation

Question 39

How long is initial burn first aid effective for after the injury?

Answer 39

3 hours

Question 40

Which zone can be prevented from damage with initial burns first aid?

Answer 40

Zone of stasis

Question 41

How long should you apply cool running water for burns initial first aid?

Answer 41

20 minutes of room temperature water (18 degrees)