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26 Juni 2013





50 years old female fell down with her right forearm in extension position.
She feel pain in her wrist area and with dinner fork deformity. Probable diagnosis
for this patient is?
a. Galleazi fracture
b. Monteggia fracture
c. Smith fracture
d. Colles fracture
e. Dislocation or the wrist joint
Sign of artery rupture are: cold, negative capillary refill, pale, no pulse and
a. Parsthesis
b. Parese
c. Paralysis
d. Vena back flow negative
e. Pain
Female 86 years old came to emergency unit who has a history fall. What
should you be evaluated on the initial step of the physical examination?
A. Shoulder, wrist, and proximal femur
B. Head and cervical spine
C. Femur and tibia diaphysis
D. Ankle and metatarsal
E. Internal bleeding
As an emergency doctor you must be able to assess the patency of the
vascular condition of an extremity distal to the injured level. Which artery
should you checked in a middle shaft humerus fracture?
a. Radial and ulnar artery.
b. Radial, ulnar and medianus artery
c. Popliteal artery
d. Axilary and radial artery
e. Humeral and axilary artery

5. Other than palpating the pulse of the artery this following simple test is also
useful to assess the patency of the vascular condition of an extremity, distal
to the injured level.
a. Capilary refill test < 4 Seconds
b. Motoric and sensoric examiation
c. Capillary refill test < 2 seconds
d. MESS score evaluation
e. None of above

6. Traction apophysitis or inflammation of the bony outgrowth that resulted to

repetitive traction is the main patophysiology for the following diseases
a. Legg Calve Perthes and Osgood Schlatter disease
b. Osgood Schlatter disease and SInding Johansson Larsens disorder
c. SInding Johansson Larsens disorder and Legg Calve Perthes
d. Osteochondroma and Legg Calve Perthes disease
e. All of the above are due to traction apophysitis

7. What kind of physical finding might you encounter in Osgood Schlatter

a. Tenderness and swelling in the tibial tuberosity
b. Deformity of the patella
c. Crepitation and locking of the knee
d. Genu varum with crepitation
e. All above are true

8. A 14-year-old girl has adolescent idiopathic scoliosis. Her parents would like
to know what kind of problems she will have compared to her peers who do
not have scoliosis. You should inform them that she will have:
a. difficulty with pregnancy in the future
b. more acute or chronic back pain
c. decreased pulmonary function regardless of the severity of scoliosis
d. limitations in athletic participation
e. increased risk of developing cancer

9. A 32-year-old man sustain an iliac wing fracture and a contralateral femur fracture.
Twelve hours later he has shortness of breath with tachypnea, hypoxia, and confusion.
A chest radiograph is normal. What is the most likely diagnosis?
A. Fat emboli syndrome
B. Adult respiratory distress syndrome
C. Pulmonary embolus
D. Tension pneumothorax
E. Sepsis

10. An elderly patient falls and sustain an extension injury to the neck that results in
upper extremity weakness, spared perianal sensation, and lower extremity spasticity.
These findings best describe what syndrome?
A. Brown-Sequard

B. Cauda equine

Severe back pain

Saddle anesthesia i.e. anesthesia or paraesthesia involving S3 to S5
dermatomes including the perineum, external genitalia and anus; or
more descriptively, numbness or "pins-and-needles" sensations of the
groin and inner thighs which would contact a saddle when riding a
Bladder and bowel dysfunction caused by decreased tone of the
urinary and anal sphincters. detrusor weaknesses causing urinary
retention and post-void residual incontinence as assessed by bladder
scanning the patient after the patient has urinated.
Sciatica-type pain on one side or both sides, although pain may be
wholly absent
Weakness of the muscles of the lower legs (often paraplegia)
Achilles (ankle) reflex absent on both sides
Sexual dysfunction
C. Anterior cord: complete loss of muscle strength below the level of injury due to
damage to the anterior 2/3 of the spinal cord containing descending motor fibres
in the corticospinal tract. Because other ascending sensory fibres are located in
the remaining 1/3 of the posterior area of the spinal cord supplied by the posterior
spinal artery, sensory loss is incomplete. In most patients sensitivity to pain and
temperature are lost whilst sensitivity to touch and proprioception (joint position)
are preserved
D. Posterior cord : Loss of proprioception + vibration sensation only
E. Central cord : Physical findings related to central cord syndrome are limited to the
neurologic system and consist of upper motor neuron weakness in the upper and
lower extremities. This impairment can be described as follows:

Impairment in the upper extremities is usually greater than in the lower

extremities and is especially prevalent in the muscles of the hand.

Sensory loss is variable, although sacral sensation is usually present. Anal

wink, anal sphincter tone, and Babinski reflexes should be tested.

Muscle stretch reflexes may initially be absent but will eventually return
along with variable degrees of spasticity in affected muscles.