CE/CME Objectives

Upon completing this program, the participants will be able to:

a.) discuss conditions that should increase suspicion for traumatic injuries;
b.) describe the various modalities used to identify different traumatic conditions;
c.) cite methods of quickly stabilizing and managing patients; and
d.) identify possible complications that may occur with traumatic injuries.

CE/CME Questions

1. When attaining a history, which of the following must be attained?
A. Hand dominance and profession
B. PMH for immunocompromising conditions, smoking status
C. Hand position at time of injury
D. Mechanism of injury
E. All of the above

2. Which one of the following pathogens is most likely associated with a 'fight bite,' and what is the preferred antibiotic of choice?
A. Staphylococcus aureus; amoxicillin + clavulanate
B. Pasturella; ceftriaxone
C. Streptococcus epidermitis; cephalexin
D. Streptococcus viridans; gentamycin
E. Eikenella corrodens; ciprofloxicin

3. Which one of the following symptoms is least concerning when evaluating for tendon injury?
A. Pain and ecchymosis at location of injury
B. Pain on palpation proximally on the injured digit
C. Inability to actively range the joint
D. Decreased passive range of motion of injured joint
E. Changes in resting position of injured joint

4. Which one of the following statements regarding flexor tendon injuries is true?
A. Open flexor tendon injues can be cared for in the ED.
B. The flexor tendon should be placed in 60 degrees of flexion.
C. Repair of complete lacerations is recommended within 24 hours
D. Flexor tendon injuries do not require referral to a hand surgeon.

5. Which one of the following neurological findings may be considered normal?
A. Two-point discrimination of 4 mm
B. Lack of palpable contraction of the thenar eminence on abduction of the 1st digit
C. No skin changes after 10 minutes of soaking
D. Subjective difference in light touch sensation between hands

6. Extensor tendon injuries of which zone may be repaired by the EP?
A. Zone I, distal phalange
B. Zone II, middle phalange
C. Zone III, PIP
D. Zone IV, proximal phalange
E. Zone V, MCP

7. Which one of the following is contraindicated in a patient with a high-pressure injury?
A. Radiographic evaluation
B. Determination of substance injected
C. Immediate referral to hand surgeon
D. Digital/regional anesthesia for pain control
E. Tetanus prophylaxis

8. Which one of the following activities is necessary when treating open wounds?
A. Immediate administration of prophylactic antibiotics
B. Recreating the position of injury during wound exploration
C. Primarily repairing all hand wounds regardless of the size
D. Soaking the wound before closure

9. Which of the following techniques will appropriately assess the flexor digitorum superficialis?
A. Comparative grip strength
B. Hand held palm up, hold the PIP in extension, and flex the DIP against resistance
C. Hand held palm up, hold the MCP in extension, and flex the PIP against resistance
D. Hand held palm down, actively extend the digit against resistance
E. Hand held ulnar side down, actively abduct the 2nd digit against resistance

10. Which one of the following fractures is considered 'stable'?
A. Rotational deformity of the 5th metacarpal
B. 20 degrees of volar angulation of the 2nd metacarpal
C. Bennett's fracture: proximal metacarpal of the 1st digit
D. Boxer's fracture: fracture of the neck of the 5th metacarpal
E. Skier's/Gamekeeper's thumb: tear of the ulnar collateral ligament and associated avulsion fracture of the base of the proximal phalange

Answers:

1. E
2. A
3. D
4. C
5. A
6. D
7. D
8. B
9. C
10. E