A 21-year-old male presents to the ED after sustaining a gunshot wound to the neck. After evaluation, it is determined that he has C6 quadriplegia.Which of the following activities will be limited by this injury?
Answer(s): B
This patient should be able to perform any activity that requires innervation from C6 or above. The biceps and deltoid are innervated by C5, so he should be able to lift his arms above his head, have shoulder flexion, and elbow flexion. C6 innervates the extensor carpi radialis, so wrist extension should be preserved. The triceps rely on C7, so he would not be able to perform elbow extension.
Patients with septic arthritis of the hip joint usually present with which position?
Answer(s): D
The joint space is most relaxed when the hip is flexed and externally rotated. This tends to be the least painful position for patients with septic arthritis
Which of the following structures can be found outside of the spermatic cord during a hernia repair?
Answer(s): A
A direct hernia comes through the medial inguinal canal floor and is found behind the spermatic cord. An indirect hernia passes though the internal inguinal ring, and thus can be found within the spermatic cord. The spermatic cord also contains the vas deferens, the testicular artery, lymphatics, and nerve fibers.
A 30-year-old male is brought to the ED after being hit in the head by a baseball. He is making incomprehensible sounds, but no words. He opens his eyes and withdraws to painful stimuli. His Glasgow Coma Scale score is:
Answer(s): C
The Glasgow Coma Scale is used to quantify a neurologic examination in patients with a head injury. It is based on three elements: eye opening, motor response, and verbal response. The total score ranges from 3 (worst) to 15 (best) with a score of 8 or lower indicating a coma. The scale is shown below. This patient has a score of 2E. + 4(M) + 2(V) = 8. This patient has evidence of a severe head injury. The initial step should be to protect his airway and prevent hypoxia, which could adversely affect his head injury. Thus, the initial step should be endotracheal intubation. Neurosurgical expertise, imaging to define the injury, and screens to rule out drugs or alcohol as contributions are all important, but should be performed after airway, breathing, and circulation are addressed. Mannitol is indicated in patients with evidence of herniation, such as those with pupillary dilatation.
A 30-year-old male is brought to the ED after being hit in the head by a baseball. He is making incomprehensible sounds, but no words. He opens his eyes and withdraws to painful stimuli.The most appropriate next step in the treatment of this patient is:
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