Interactive discussion session held at Emergency Medicine Update Course held at Cairo, Egypt. Presented by Dr Noureldin. www.emeregypt.org

1. ABDEL H NOURELDIN
PROGRAM DIRECTOR
CHAIRMAN SCIENTIFIC COMMITTEE
EMIRATES SOCIETY OF EMERGENCY MEDICINE
TAWAM HOSPITAL EMERGENCY MEDICINE RESIDENCY PROGRAM
EMERGENCY MEDICINE UPDATE
JUNE - 12TH-2013
Radiology cases
In Egypt

2. 20 y/o was involved in
a fight
he was stabbed in the
left lower chest.

3. 7: the patient in the picture below presented to the ED with stab
wound in the anterior abdominal wall. Which of the following
statement is correct?
A: Blind probing with fingers are accurate
and safe during local wound
exploration of the anterior abdominal wall.
B: Blind probing Cotton tipped swabs
are accurate and safe during local
wound exploration of the anterior abdominal wall.
C: Blind probing with instruments swabs
are accurate and safe during local wound exploration
of the anterior abdominal wall.
D: Blind probing of chest injuries adds no potential
additional information and may be hazardous.

6. E-FAST IS NORMAL

8. 33 Y/O WAS INVOLVED IN
A RTA
HE WAS EJECTED OUT OF
THE CAR
BP =70, P=140

10. 33 Y/O WAS INVOLVED IN
A RTA
HE WAS EJECTED OUT OF
THE CAR
BP =30, P=45

12. 33 Y/O WAS INVOLVED IN
A RTA
HE WAS EJECTED OUT OF
THE CAR
BP =75 SYSTOLIC, P=65

13. E-FAST IS NORMAL

16. 17 y/o male who was involved
in RTA. Patient was ejected
out of the car and his BP is
70/40, Pulse of 130, and
patient is cold and clammy.

20. Pelvic Fracture. In the setting of pelvic
fracture, the clinical triage determinant
is the presence or absence of
hemoperitoneum (Fig. 43-13). Although the
sensitivity of FAST US inpatients with
pelvic fractures is decreased, it still
serves as a tool to triage the patient to
the next intervention.116 In an unstable
patient, a positive FAST US is followed by
a supraumbilical peritoneal aspirate. If
this reveals 10 mL or greater of blood,
then the patient should expeditiously move
to laparotomy. If instead urine or other
fluid is aspirated, then the patient

28. Terry Thomas sign & signet ring
sign

29. Perilunate dislocation stage II &
III

32. 9: Patient complain of elbow pain after a fall and the x-ray is
shown below. Which of the following statements is correct? patient ?
A: Patient has positive anterior fat pad sign , positive posterior fat
pad sign and positive anterior humeral line.
B: : Patient has negative anterior fat pad sign , positive posterior
fat pad sign and positive anterior humeral line.
C: : Patient has positive anterior fat pad sign , negative posterior
fat pad sign and positive anterior humeral line.
D: : Patient has positive anterior fat
pad sign , positive posterior fat pad sign
and negative anterior humeral line.
E: : Patient has negative anterior fat
pad sign , negative posterior fat pad sign
and negative anterior humeral line.

33. #9
A
Rosen’s 7th
edition
pages # 547-

34. FAT PAD SIGN

35. ANTERIOR HUMERAL LINE

37. 7: Which of the following is the most
common type of Salter -Harris fracture ?
A:
B:
C:
D:

38. #7
D
Rosen’s 7th edition
pages 2245 - 2249

40. 8: Which of the following type of Salter -
Harris fracture has the greater likelihood
of growth arrest ?
A:
B:
C:
D:

41. #8
B
Rosen’s 7th edition
pages 2245 - 2249

43. 9: which of the following is the
greenstick fracture?
A:
B:
C:
D:

44. #9
D
Rosen’s 7th edition
pages 2245 - 2249

45. 10: which of the following is the Torus
fracture?
A:
B:
C:
D:

46. #10
C
Rosen’s 7th edition
pages 2245 - 2249

47. 23: Which of the following is the name of this injury seen on the x-
ray below?
A: Torus
B: Green stick
C: Plastic deformity
D: Hutchinson’s fracture
E: None of the above

48. #23
C
Rosen’s 7th
edition
page 543

49. PLASTIC
DEFORMITY

50. PLASTIC
DEFORMITY

51. # 10: 16 y/o fill down and complain of pain and
swelling of the left wrist. X-ray is shown
below. Choose the correct statement.
A: Normal lateral view of the
wrist
B: Fracture of the Lunate bone
C: Fracture of the Hamate bone
D: Fracture of theTriquetrium
bone

52. #10
D
Rosen’s 7th
edition
page 531

53. 6: The patient of the x-ray below was brought to the ED
because of pain and swelling of the wrist after a fall.
Which of the following statement about the x-ray is
correct?
A: Patient has no fracture seen on the x-ray.
B: Patient has positive clenched fist sign
C: Patient has positive carpal tunnel view
D: Patient has a positive pronator quadratus sign
E: None of the above

54. #6
D
Rosen’s 7th
edition
page 529

55. PRONATOR QUADRATUS FAT PAD SIGNE
NORMAL
POSITIVE

56. 12: The child shown in the picture was brought to the ED because he is
not using his left arm and is holding his left wrist with right hand.
Which of the following is the best method of treating this child?
A: X-ray of the upper arm and forearm and if negative to see
orthopedic in AM.
B: Flexion and supination of the elbow
C: x-ray of the wrist if neg to see orthopedic surgeon in 2 to 3
days.
D: Hyperpronation

57. #12
D
Rosen’s 7th
edition
page # 549

60. 6: Which of the following age does the
ossification center of the trochlea
appers?
A: 3
B: 5
C: 7
D: 9
E: 11

61. #6
C
Rosen’s 7th
edition
page # 549

62. CRITOE
CRITOE (also known as CRITOL) helps
remember the order elbow ossification
centers.
C : capitellum : 1 year
R : radial head : 3 years
I : internal (medial) epicondyle : 5 years
T : trochlea : 7 years
O : olecranon : 9 years
E : external (lateral) epicondyle : 11 years

63. 15: patient
complain of
locked right arm
and he is unable to
move it. Please
choose the correct
diagnoses
A: Luxatio Erecta
B: anterior subluxation
C: anterior dislocation
D: posterior dislocation

64. #15
A
Rosen’s 6th edition
pages 692-693

65. 13: Which of the following methods of reducing
an anterior shoulder dislocation is associated
with the highest incidence of complication and is
no longer recommended?
A: Leidelmeyer maneuver.
B: Cooper and Milch maneuver.
C: Hippocratic method and Kocher
maneuver.
D: Stimson technique.
E: scapular manipulation technique

66. #13
C
Rosen’s 6th
edition
pages 688-690

70. STIMSONTECHNIQUE

73. LIEDELMEYER MANEUVER

75. Milch maneuver

79. 16: The most likely cause of the injury
shown on the x-ray of this patient is
child abuse.
A: True
B: False

80. #16
B
Rosen’s 7th edition
pages 2255-2257

81. 11: 7 y/o male was brought to the ED because injury to the elbow.
Patient complain of severe pain of the forearm and the pain increase
when he passively moves his fingers. Which of the following is the
most important step in managing this patient?
A: Reduce the fracture to release the median nerve
B: Measure the pressure in the compartments
C: Splint the arm and discharge to see orthopedic in AM
D: Reduce the fracture to release
the brachial artery
E: reduce the fracture to release
the radial nerve

82. #11
B
Rosen’s 7th edition
pages 2245 - 2249

83. VOLKMAN’S CONTRACTION

84. GARTLAND CLASSIFICATION

85. GARTLAND TYPE I

86. Gartland type II