USMLE Forum Archives - USMLE Step 2 CK - surgery
surgery
HIV - 12-31-07 12:40
A 45-year-old man is struck by a motor vehicle and is transported by a med flight to the local emergency department. He is reported to be intoxicated with a Glasgow score of 12/15 on the scene of the accident. He was struck by a vehicle while crossing the street. On arrival, the patient is awake and somewhat combative. He is alert to person only. His temperature is 37.0 C (98.6 F), blood pressure is 150/80 mm Hg, pulse is 112/min, and respirations are 20/min. Primary survey reveals a well-developed man in mild distress. He is in a cervical collar. He has obvious lower extremity tibia fractures bilaterally and a laceration on his forehead. The most appropriate manner to clear the patient’s cervical spine from injury is
A. cervical spine plain radiographs
B. CT scan of the neck
C. flexion, extension, and lateral rotation of the neck while assessing any pain response from the patient
D. manual palpation of the patient’s neck for any obvious injury
E. this patient cannot have his cervical spine cleared at this time
HIV - 12-31-07 12:40
A 45-year-old man is struck by a motor vehicle and is transported by a med flight to the local emergency department. He is reported to be intoxicated with a Glasgow score of 12/15 on the scene of the accident. He was struck by a vehicle while crossing the street. On arrival, the patient is awake and somewhat combative. He is alert to person only. His temperature is 37.0 C (98.6 F), blood pressure is 150/80 mm Hg, pulse is 112/min, and respirations are 20/min. Primary survey reveals a well-developed man in mild distress. He is in a cervical collar. He has obvious lower extremity tibia fractures bilaterally and a laceration on his forehead. The most appropriate manner to clear the patient’s cervical spine from injury is
A. cervical spine plain radiographs
B. CT scan of the neck
C. flexion, extension, and lateral rotation of the neck while assessing any pain response from the patient
D. manual palpation of the patient’s neck for any obvious injury
E. this patient cannot have his cervical spine cleared at this time
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#3
Re: surgery 8401glacieres - 01-06-08 13:18 CT Scan of the neck. Even though radiograp can give a clue, he should be evaluated by a CT because it gives a clear image of spinal cord trauma( Cavitation,,,,,,,,,, cervical trauma is the leading cause for syrinx formation)
#4
Re: surgery radhamesramos - 01-29-08 13:48 B, although C is an option, but not in the mechanism of this patient and his GCS
#5
Re: surgery TheOne - 02-01-08 23:16 Why not A?? I used to do "A" to every patient with an RTA.
AP + Lat. C.Spine views are fast, cheap and reliable.
#6
Re: surgery radhamesramos - 02-03-08 19:45 I think CT is better to clear the patient. Cspine views are excellent, but I guess that a CT clears the patient better and if you have the tchnology...why not use it? My humble opinion
#9
Re: surgery laparotomy - 02-28-08 12:00 
posted by HIV on 12-31-07 12:40
A 45-year-old man is struck by a motor vehicle and is transported by a med flight to the local emergency department. He is reported to be intoxicated with a Glasgow score of 12/15 on the scene of the accident. He was struck by a vehicle while crossing the street. On arrival, the patient is awake and somewhat combative. He is alert to person only. His temperature is 37.0 C (98.6 F), blood pressure is 150/80 mm Hg, pulse is 112/min, and respirations are 20/min. Primary survey reveals a well-developed man in mild distress. He is in a cervical collar. He has obvious lower extremity tibia fractures bilaterally and a laceration on his forehead. The most appropriate manner to clear the patient’s cervical spine from injury is
A. cervical spine plain radiographs
B. CT scan of the neck
C. flexion, extension, and lateral rotation of the neck while assessing any pain response from the patient
D. manual palpation of the patient’s neck for any obvious injury
E. this patient cannot have his cervical spine cleared at this time
A 45-year-old man is struck by a motor vehicle and is transported by a med flight to the local emergency department. He is reported to be intoxicated with a Glasgow score of 12/15 on the scene of the accident. He was struck by a vehicle while crossing the street. On arrival, the patient is awake and somewhat combative. He is alert to person only. His temperature is 37.0 C (98.6 F), blood pressure is 150/80 mm Hg, pulse is 112/min, and respirations are 20/min. Primary survey reveals a well-developed man in mild distress. He is in a cervical collar. He has obvious lower extremity tibia fractures bilaterally and a laceration on his forehead. The most appropriate manner to clear the patient’s cervical spine from injury is
A. cervical spine plain radiographs
B. CT scan of the neck
C. flexion, extension, and lateral rotation of the neck while assessing any pain response from the patient
D. manual palpation of the patient’s neck for any obvious injury
E. this patient cannot have his cervical spine cleared at this time
A and B cannot be done because he is combative
C should be done by those who wish to paralyse him in a barbaric way
D Is a very funny joke
E looks like the right answer but is it?
I would get anaesthesia in, intubate him (using GA) and then do a CT. That is the safest most ethical thing to do....
#11
Re: surgery laparotomy - 02-29-08 14:26 posted by radhamesramos on 02-29-08 09:32
So, Ct is the answer
So, Ct is the answer
Well yeah....But with sedation...
#12
Re: surgery ammulufy - 06-28-10 20:49 Since d cervical collar is kept at d scene of accident itself.......no more further palpation of d cervical spine is required n shud be kept on complete immobilisation in fear of any injury to d nerves in d vicinity.....however d next step is to go for a plain radiograph of d cervical spine....hence I go wid 1 as d answer.
#13
Re: surgery babbu5508 - 06-29-10 03:05 A. cervical spine plain radiographs ....because this is the most preliminary test that should be done in any case of RTA with suspected fracture.
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