A 45-year-old female presents with a history of a direct blow over the shaft of her left humerus. Her x-ray shows a spiral fracture of the distal third of the humerus. On examination of her hand, sensation is intact on the palmar side but absent on the dorsum of her hand.
Which one of the following nerves is most likely injured?
Correct Answer D: The radial nerve provides cutaneous innervation to the dorsum of the hand. As such, an injury to that nerve can cause deficient sensation on the dorsum (back of) the hand. Because she has intact sensation on the palmar surface of her hand, her median and ulnar nerves are not likely injured.
What is the most common cause of small intestinal obstruction in males over 65 years?
Correct Answer A: The most common cause of small bowel obstruction (SBO) is postsurgical adhesions. Postoperative adhesions can be the cause of acute obstruction within 4 weeks of surgery or of chronic obstruction decades later. The incidence of SBO parallels the increasing number of laparotomies performed in developing countries.
The second most common identified cause of SBO is an incarcerated groin hernia. Other etiologies of SBO include malignant tumor (20%), hernia (10%), inflammatory bowel disease (5%), volvulus (3%), and miscellaneous causes (2%). The causes of SBO in pediatric patients include congenital atresia, pyloric stenosis, and intussusception.
What is the most common etiology of small bowel obstruction?
Correct Answer A: Etiology of small bowel obstruction (SBO) Common causes of SBO are adhesions (60%), hernias (20%), neoplasms (15%) and strictures (e.g. Crohn’s). Other causes include: volvulus, foreign bodies, congenital malformations, cystic fibrosis and an annular pancreas.
PEARL: Adhesions are the most common cause of SBO.
A 35 year old woman is seen in the emergency department because of the sudden onset of severe low back pain 12 hours earlier. Careful physical examination, including a neurologic examination, is normal except for evidence of muscle spasm. She believes she has a herniated disc because 2 years ago her father developed the sudden onset of back pain that required immediate surgery.
She returns 3 weeks later because of persistent left lower leg pain and a weak left ankle-jerk reflex. In addition to pain management, which of the following is the most appropriate step at this time?
Correct Answer D: The symptoms now suggest a radiculopathy because of the left lower extremity pain, and the weak left ankle-jerk reflex. Therefore, consideration of a disc bulge or herniation must be considered. The most effective diagnostic imaging of this region is an MRI of the lumbosacral spine, not an x-ray, CT scan, or diskography. Observation is inappropriate as she has symptoms of a radiculopathy and should be further evaluated with an MRI.
A 19 year old woman is brought to the emergency room following involvement in a motor vehicle accident. On examination, she has a Glascow coma scale (GCS) of 10 and swelling over the occipital protuberance.
The most appropriate imaging study is:
Correct Answer D: In suspected intracranial bleeds it is important to do a CT of the head without contrast. The reason is because both contrast and blood look white on a CT image. Therefore contrast is not indicated in the imaging of the head, during an episode of likely intracranial bleeding or hemorrhage.
CT of the head with contrast is done when a tumor or intracranial mass is suspected, for example in a patient that presents with headache, vomiting and papilledema.
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