1. Mathias Christianson, MD 5/20/10
Book Review Ch 44-46
Mathias Christianson, MD
5/20/10

2. Injuries to the upper extremity may be classified as
Closed crush
Simple laceration
Open crush with partial amputation
Complete amputation
All of the above

3. Injuries to the upper extremity may be classified as
Closed crush
Simple laceration
Open crush with partial amputation
Complete amputation
All of the above

4. The correct area for assessment of sensation in the radial nerve is
Volar tip of index finger
Volar tip of little finger
First dorsal web space
Squeeze the thumb as hard as possible for 30 seconds

5. The correct area for assessment of sensation in the radial nerve is
Volar tip of index finger
Volar tip of little finger
First dorsal web space
Squeeze the thumb as hard as possible for 30 seconds

6. A 25 y/o man presents after lacerating his 5th finger just proximal to the MCP joint on the palmar surface. The best technique for anesthesia to explore this wound effectively is:

7. Digital block of the 5th phalanx
Median nerve wrist block
Radial nerve wrist block
Topical anesthesia
Ulnar nerve wrist block

8. Digital block of the 5th phalanx
Median nerve wrist block
Radial nerve wrist block
Topical anesthesia
Ulnar nerve wrist block

9. Adequate motor testing of the ulnar nerve includes
Adduction/abduction of digits
Dorsiflexion of the wrist
Thumb abduction away from the palm
Thumb interphalangeal joint flexion

10. Adequate motor testing of the ulnar nerve includes
Adduction/abduction of digits
Dorsiflexion of the wrist
Thumb abduction away from the palm
Thumb interphalangeal joint flexion

11. Where should digital two-point discrimination be tested?
Just the tip
Along the ulnar surface
Along the midline dorsal surface
Along the radial surface
Along the midline palmar surface
B & D
C &E

12. Where should digital two-point discrimination be tested?
Just the tip
Along the ulnar surface
Along the midline dorsal surface
Along the radial surface
Along the midline palmar surface
B & D
C &E

13. Movie quote trivia: I'm just a big hairy American winning machine, you know?
Blades of Glory
Talladega Nights
Walk Hard
The Hangover
Superbad

14. Movie quote trivia: I'm just a big hairy American winning machine, you know?
Blades of Glory
Talladega Nights
Walk Hard
The Hangover
Superbad

15. What is “normal” two-point discrimination defined as?
2 mm
6 mm
8 mm
12 mm

16. What is “normal” two-point discrimination defined as?
2 mm
6 mm
8 mm
12 mm

17. What is the recommended time limit when using a rubber tourniquet for digital injuries?
5-10 minutes
10-15 minutes
15-20 minutes
20-30 minutes
Whatever works so long as the finger quits bleeding so the laceration can be repaired

18. What is the recommended time limit when using a rubber tourniquet for digital injuries?
5-10 minutes
10-15 minutes
15-20 minutes
20-30 minutes
Whatever works so long as the finger quits bleeding so the laceration can be repaired

19. What is the recommended time limit when using a pneumatic cuff tourniquet for proximal injuries?
15 minutes
30 minutes
45 minutes
1 hour
Whatever the on call hand surgeon tells you…

20. What is the recommended time limit when using a pneumatic cuff tourniquet for proximal injuries?
15 minutes
30 minutes
45 minutes
1 hour
Whatever the on call hand surgeon tells you…

21. There are __ extensor compartments and __ flexor tendons in the forearm
12, 6
4, 8
8, 10
6,12

22. There are __ extensor compartments and __ flexor tendons in the forearm
12, 6
4, 8
8, 10
6,12

23. Which tendon injuries are typically repaired by the EM physician?
Anything the physician is comfortable with
Extensor tendon injuries between distal wrist and MCP joints
Any extensor tendon injury
Flexor tendon injuries between the distal wrist and MCP joints

24. Which tendon injuries are typically repaired by the EM physician?
Anything the physician is comfortable with
Extensor tendon injuries between distal wrist and MCP joints
Any extensor tendon injury
Flexor tendon injuries between the distal wrist and MCP joints

25. Digital nerve injuries are classified as which of the following?
Neuropraxia
Axonotmesis
Neurotmesis
All of the above
None of the above

26. Digital nerve injuries are classified as which of the following?
Contusion (neuropraxia)
Crush (axonotmesis)
Transection (neurotmesis)
All of the above
None of the above

27. Movie quote trivia: Mom! The meat loaf!
Anchorman
Superbad
The Hangover
Wedding Crashers

28. Movie quote trivia: Mom! The meat loaf!
Anchorman
Superbad
The Hangover
Wedding Crashers

29. A 34 y/o male presents with an injury to his right hand
A 34 y/o male presents with an injury to his right hand. He was working with a paint spray gun 30 min ago when the stream contacted his hand and penetrated the skin. There is minimal pain to the right index finger and a small entrance wound on the palmar surface. Neurovascular exam is normal. The patient wants something for pain and to be D/C to get back to work. What is the most appropriate management?

30. Arrange outpatient hand surgery follow up in 24 hours, tx with tylenol, and D/C
Obtain emergent hand surgery consult immediately
Tx with tylenol, obtain XR, and if no fractures, D/C with routine follow up
Tx with tylenol and digital nerve block, give ABX, and D/C with appropriate follow up
Tx with ABX and tylenol, obtain XR, D/C if no fracture

31. Arrange outpatient hand surgery follow up in 24 hours, tx with tylenol, and D/C
Obtain emergent hand surgery consult immediately
Tx with tylenol, obtain XR, and if no fractures, D/C with routine follow up
Tx with tylenol and digital nerve block, give ABX, and D/C with appropriate follow up
Tx with ABX and tylenol, obtain XR, D/C if no fracture

32. What is the amputation rate for high pressure injection injuries?
2-5%
5-17%
16-55%
27-72%

33. What is the amputation rate for high pressure injection injuries?
2-5%
5-17%
16-55%
27-72%

34. Regarding digital tip injuries with bone exposure, which typically has the most favorable prognosis?
Volar angulation
Dorsal angulation
Transverse angulation

35. Regarding digital tip injuries with bone exposure, which typically has the most favorable prognosis?
Volar angulation
Dorsal angulation
Transverse angulation

36. A 58 y/o man presents with a finger amputation sustained while cleaning a lawnmower. The right index finger is completely amputated at the level of the middle phalanx. There are normal vital signs and arterial bleeding from the site. The finger was placed in a plastic bag in an ice filled cooler. There is gross debris on the site and the amputated finger. What is the next step to improve chances of successful replantation?

37. Gently wash both the amputated finger and the site with providone-iodine solution or hydrogen peroxide and replace the digit in ice
Leave the digit in the cooler
Remove the part from the cooler, wrap with saline soaked gauze and place in a refrigerator
Send the part to pathology
Warm the part to room temperature, then rinse it and wrap it with gauze

38. Gently wash both the amputated finger and the site with providone-iodine solution or hydrogen peroxide and replace the digit in ice
Leave the digit in the cooler
Remove the part from the cooler, wrap with saline soaked gauze and place in a refrigerator
Send the part to pathology
Warm the part to room temperature, then rinse it and wrap it with gauze

39. Which bacteria is commonly associated with farming accidents?
Acinetobacter calcoaceticus
Pasteurella multocida
Clostridium perfringes
Capnocytophaga canimorsus
None of the above

40. Which bacteria is commonly associated with farming accidents?
Acinetobacter calcoaceticus
Pasteurella multocida
Clostridium perfringes
Capnocytophaga canimorsus
None of the above

41. Movie quote trivia: I'm not supposed to be within two hundred feet of a school... or a Chuck E. Cheese.
The Hangover
Superbad
Anchorman
Role Models

42. Movie quote trivia: I'm not supposed to be within two hundred feet of a school... or a Chuck E. Cheese.
The Hangover
Superbad
Anchorman
Role Models

43. Which bacteria is commonly associated with wading in freshwater streams?
Aeromonas hydrophila
Pasteurella multocida
Acinetobacter calcoaceticus
Capnocytophaga canimorsus
B &D
None of the above

44. Which bacteria is commonly associated with wading in freshwater streams?
Aeromonas hydrophila
Pasteurella multocida
Acinetobacter calcoaceticus
Capnocytophaga canimorsus
B &D
None of the above

45. Testing motor function of the superficial peroneal nerve involves
Foot inversion
Ankle plantarflexion
Ankle dorsiflexion
Foot eversion
A & C
None of the above

46. Testing motor function of the superficial peroneal nerve involves
Foot inversion
Ankle plantarflexion
Ankle dorsiflexion
Foot eversion
A & C
None of the above

47. Testing motor function of the deep peroneal nerve involves
Foot inversion
Ankle plantarflexion
Ankle dorsiflexion
Foot eversion
A & C
None of the above

48. Testing motor function of the deep peroneal nerve involves
Foot inversion
Ankle plantarflexion
Ankle dorsiflexion
Foot eversion
A & C
None of the above

49. Testing motor function of the posterior tibial nerve involves
Foot inversion
Ankle plantarflexion
Ankle dorsiflexion
Foot eversion
A & C
None of the above

50. Testing motor function of the posterior tibial nerve involves
Foot inversion
Ankle plantarflexion
Ankle dorsiflexion
Foot eversion
A & C
None of the above

51. Which location is used to test the sensory function of the deep peroneal nerve?
Dorsum of the foot adjacent to digits 2-5
First web space of the foot
The plantar surface of the foot
The area over the medial maleolus

52. Which location is used to test the sensory function of the deep peroneal nerve?
Dorsum of the foot adjacent to digits 2-5
First web space of the foot
The plantar surface of the foot
The area over the medial maleolus

53. Which location is used to test the sensory function of the superficial peroneal nerve?
Dorsum of the foot adjacent to digits 2-5
First web space of the foot
The plantar surface of the foot
The area over the medial maleolus

54. Which location is used to test the sensory function of the superficial peroneal nerve?
Dorsum of the foot adjacent to digits 2-5
First web space of the foot
The plantar surface of the foot
The area over the medial maleolus

55. Which location is used to test the sensory function of the posterior tibial nerve?
Dorsum of the foot adjacent to digits 2-5
First web space of the foot
The plantar surface of the foot
The area over the medial maleolus

56. Which location is used to test the sensory function of the posterior tibial nerve?
Dorsum of the foot adjacent to digits 2-5
First web space of the foot
The plantar surface of the foot
The area over the medial maleolus

57. Movie quote trivia: I'm very important
Movie quote trivia: I'm very important. I have many leather-bound books and my apartment smells of rich mahogany
Wedding Crashers
Anchorman
Superbad
The Hangover

58. Movie quote trivia: I'm very important
Movie quote trivia: I'm very important. I have many leather-bound books and my apartment smells of rich mahogany
Wedding Crashers
Anchorman
Superbad
The Hangover

59. Where would one inject lidocaine for regional anesthesia to the entire plantar surface?
At the base of the heel
1 cm posterior to the distal aspect of the lateral malleolus
Intra-articular injection into the ankle
Into the area posterior to the distal aspect of the medial malleolus
B & D

60. Where would one inject lidocaine for regional anesthesia to the entire plantar surface?
At the base of the heel
1 cm posterior to the distal aspect of the lateral malleolus
Intra-articular injection into the ankle
Into the area posterior to the distal aspect of the medial malleolus
B & D (Sural and posterior tibial blocks)

61. What is the time limit for wound closure with minimal risk of infection?
2 hours
5 hours
8 hours
12 hours
None of the above

62. What is the time limit for wound closure with minimal risk of infection?
2 hours
5 hours
8 hours
12 hours
None of the above as this is unknown

63. Lacerations sustained while wading in freshwater streams should receive antibiotic prophylaxis…
True
False
Depends on the clinical situation

64. Lacerations sustained while wading in freshwater streams should receive prophylaxis…
True
False
Depends on the clinical situation
Tx with flouroquinolone, TMP/SMX, or aminoglycoside

65. Plain radiography will detect what percentage of foreign bodies?
15-30%
40-50%
65-75%
80-90%

66. Plain radiography will detect what percentage of foreign bodies?
15-30%
40-50%
65-75%
80-90%

67. What are the indications for foreign body removal?
Potential for inflammatory reaction/infection
Toxicity
Cosmetic problems
Potential for further/later injury
All of the above

68. What are the indications for foreign body removal?
Potential for inflammatory reaction/infection
Toxicity
Cosmetic problems
Potential for further/later injury
All of the above

69. Which of the following foreign bodies must be removed?
Small, inert, deeply imbedded objects with no associated symptoms
Bullets that rest deep within a muscle belly
Subungual foreign bodies
All of the above

70. Which of the following foreign bodies must be removed?
Small, inert, deeply imbedded objects with no associated symptoms
Bullets that rest deep within a muscle belly
Subungual foreign bodies
All of the above

71. What is considered a sufficient and reasonable amount of time for removal of most foreign bodies?
5-10 minutes
15-30 minutes
30-45 minutes
45-60 minutes
As long as it takes

72. What is considered a sufficient and reasonable amount of time for removal of most foreign bodies?
5-10 minutes
15-30 minutes
30-45 minutes
45-60 minutes
As long as it takes

73. Which technique is best to remove deeply penetrating fishhooks?
Advance-and-cut
Needle cover
String-pull
Incision
Simple retrograde

74. Which technique is best to remove deeply penetrating fishhooks?
Advance-and-cut
Needle cover
String-pull
Incision
Simple retrograde

75. Movie quote trivia: The Snozzberries taste like Snozzberries.
Superbad
Walk Hard
Super Troopers
Anchorman

76. Movie quote trivia: The Snozzberries taste like Snozzberries.
Superbad
Walk Hard
Super Troopers
Anchorman