Case-based MCQ

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The correct answer is A. Mid-facial fractures commonly occur with blunt trauma to the face and are classified by their involvement of different areas of the mid-face. Le Fort injuries often present dramatically, with significant hemorrhage, early swelling, bilateral orbital ecchymosis, and cerebrospinal fluid leaks in Le Fort II and III injuries. Patients with Le Fort injuries often present with significant hemorrhage, requiring airway protection and nasal packing. Oral packing is often required for control of fractures involving the hard palate. Although CT scanning will be the definitive diagnostic tool in any facial fractures, a clinical exam can identify the type of fracture you expect to see. Further management will include antibiotics, tetanus prophylaxis, pain management, and surgical repair. Le Fort I is a fracture through the pterygoid plate and nasal septum that allows free movement of the hard palate and teeth. Le Fort II involves the central maxilla as well as the hard palate and free movement of the nose is included. Le Fort III is a fracture involving the frontozygoma, orbit, through the nose, and ethmoids. The hard palate through the inferior orbits are mobile in this case. Le Fort IV is any involvement of the frontal bone. Choice B is not correct: Le Fort II involves the central maxilla as well as the hard palate and free movement of the nose is included. Choice C is not correct: Le Fort III is a fracture involving the frontozygoma, orbit, through the nose, and ethmoids. The hard palate through the inferior orbits are mobile in this case. Choice D is not correct: Le Fort IV is any involvement of the frontal bone. Summarized Points: One way to assess for Le Fort fractures is to stabilize the forehead with one hand and rock the hard palate with the other.  If just the hard palate moves you can assume Le Fort I, if the nasal bridge moves it is associated with Le Fort II, and if the inferior orbits move then a Le Fort III is likely present.

🧠 Case-based MCQ 🔸 #MCQ_18 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 32-year-old man arrives as a trauma activation. He was riding a mountain bike downhill when he lost control and went over the handlebars. He was wearing a helmet however presents with severe facial pain and trauma. While stabilizing his forehead with one hand and using the other hand to gently rock the hard palate, only the hard palate and teeth move.

🧠 Case-based MCQ 🔸 #MCQ_17 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is C. The patient has an acute arterial occlusion, which is associated with the six P’s—Pain, Pallor, Paresthesias, Paralysis, Poikilothermia, and Pulseless (absence of pulse). The most likely cause is an embolus, but trauma could also be responsible. In an embolic arterial occlusion, there is no antecedent history of claudication pain. Emboli can spring from a recent myocardial infarct, mitral stenosis, artificial heart valve, or an aortic aneurysm. The condition occurs suddenly. The limb is cold to touch, and loss of motor function generally ensues within hours after onset of pain. For this reason, embolic arterial occlusion is an emergency. The first loss of function is the inability to move the toes. (In the case of venous occlusion, on the other hand, motor function is not lost.) Immediately anticoagulation with intravenous heparin followed by embolectomy and thrombectomy is the preferred treatment. The popliteal artery is the most susceptible vessel for occlusion because it is commonly affected by atherosclerosis and is a small-caliber artery. ❌Choice A is not correct: Superficial thrombophlebitis in the saphenous system of the legs presents with pain and tenderness along the course of the vessel. ❌Choice B is not correct: A herniated disk would not be expected to involve the whole leg, nor would it present with the given symptom/sign complex. A history of back pain followed by pain going down the leg (radicular pain) would be usual. Findings would include hypesthesia along the lateral or inner aspect of the leg, depending on which intervertebral disk has herniated, and weakness of the plantar or dorsiflexors of the foot. Straight leg raise test would be positive, and the deep tendon jerks may or may not be affected, depending on the level of herniation. The pulses will be normal, and skin temperature would be normal. ❌Choice D is not correct: Deep venous insufficiency is associated with superficial varicose veins and stasis dermatitis around the ankle. ❌Choice E is not correct: Hypovolemic shock produces hypotension, generalized pallor, and cold, clammy skin. ✅Summarized Points: Acute occlusion of an artery, usually caused by embolization which present with the six P’s—Pain, Pallor, Paresthesias, Paralysis, Poikilothermia, and Pulseless (absence of pulse). Immediately anticoagulation with intravenous heparin followed by embolectomy and thrombectomy is the preferred treatment

🧠 Case-based MCQ 🔸 #MCQ_16 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 68-year-old man with a long history of coronary artery disease and recent history of myocardial infarction is seen in the emergency room with a history of sudden onset of pain in the right leg. The patient also complained of numbness in the leg. Physical examination revealed pallor of the right leg, the skin was cool to the touch, and the patient had difficulty in moving his toes. Raising his leg increased the pallor, and the dorsalis pedis pulse could not be felt.

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🧠 Case-based MCQ 🔸 #MCQ_16 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is D. The patient displays many of the characteristics and feelings that are seen in borderline personality disorder. These patients often have childhoods that are characterized by inconsistent parenting and often a significant amount of abuse. The parents may not reinforce the validity of the patient’s inner feelings. The patients tend to divide people into all good or all bad categories, a well-known phenomenon termed “splitting.” They often have chronic feelings of emptiness and have many relationships that are labile in nature. Borderline patients have severe trouble regulating their emotions, as seen when the patient could not control her own anger at the therapist, and are therefore very impulsive. ❌ Choice A is not correct: The patient does not show a consistent disregard for the rules of society and the rights of others, which is characteristic of antisocial personality disorder. ❌ Choice B is not correct: The patient does not discuss being extremely afraid of situations that may result in interpersonal rejection, a key characteristic of avoidant personality disorder. ❌ Choice C is not correct: Although the patient displays shallow emotions, a characteristic of histrionic personality disorder, she also displays splitting, impulsivity, and volatile characteristics more indicative of a borderline personality disorder. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. ❌ Choice E is not correct: The patient does not exhibit grandiosity in her self-perception, making narcissistic personality disorder less likely. ✅ Summarized Points: The borderline personality disorder patient often has childhoods that are characterized by inconsistent parenting and often a significant amount of abuse.

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🧠 Case-based MCQ 🔸 #MCQ_16 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 A 28-year-old female psychiatry patient is extremely interested in everything the physician says, exclaiming, “Wow, doctor, you really understand me, you’re the best!” She tells the physician about the verbal abuse that she suffered during her childhood from a mother who gave her notably inconsistent parenting. She says that she currently feels empty inside, like she has no direction. She discusses the large number of tumultuous relationships that she has had throughout her life, giving vague reasons as to why they have not worked out. When the physician asks her to describe herself further, she states that she is “impulsive.” When the physician suggests that her personality structure may be to blame, she screams, “You’re just like the rest of them!” and runs out.

🧠 Case-based MCQ 🔸 #MCQ_15 🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤🔤 The correct answer is A. Preterm infants are at higher risk for vaccine-preventable diseases than term infants and should be vaccinated based on their chronological (absolute) age rather than adjusting for prematurity. Immunizations elicit robust, protective antibody responses in preterm infants. Therefore, clinically stable preterm infants should receive standard immunizations based on the routine immunization schedule, even if they are still in the neonatal intensive care unit. ❌Choice B is not correct: Most centers in Canada delay rotavirus vaccination until hospital discharge, as it is a live virus and could theoretically be transmitted to other infants. ❌Choice C is not correct: Infants born prematurely are more likely than term infants to contract vaccine-preventable diseases, so their vaccinations should be based on their chronological (absolute) age rather than adjusting for prematurity. ❌Choice D and E are not correct: The exceptions include hepatitis B and rotavirus vaccines. For infants with <2 kg (4.4 Ib) birth weight who are born to hepatitis B surface antigen-negative mothers, hepatitis B vaccination should be delayed until age 30 days or hospital discharge (whichever comes first) due to potentially lower immunogenicity at lower birth weights. Infants born to hepatitis B surface antigen-positive mothers should receive hepatitis B vaccine and hepatitis B immune globulin within 12 hours regardless of birth weight. ✅ Summarized Points: Preterm infants are at higher risk for vaccine-preventable infections and should follow the standard immunization schedule and receive most immunizations based on their chronological age.

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