136.A 29-year-old man is brought to the ED by EMS after being stabbed in
the left side of his back. His BP is 120/80 mm Hg, HR is 105 beats per
minute, RR is 16 breaths per minute, and oxygen saturation is 98% on room
air. On the secondary survey, you note motor weakness of his left lower
extremity and the loss of pain sensation in the right lower extremity. Which
of the following is the most likely diagnosis?
a. Spinal shock
b. Central cord syndrome
c. Anterior cord syndrome
d. Brown-Séquard syndrome
e. Cauda equina syndrome
137.A 33-year-old man, who was drinking heavily at a bar, presents to the
ED after getting into a fight. A bystander tells paramedics that the patient
was punched and kicked multiple times and sustained multiple blows to
his head with a stool. In the ED, his BP is 150/75 mm Hg, HR is 90 beats
per minute, RR is 13 breaths per minute, and oxygen saturation is 100% on
non-rebreather. On examination, he opens his eyes to pain and his pupils
are equal and reactive. There is a laceration on the right side of his head.
He withdraws his arm to pain but otherwise doesn’t move. You ask him
questions, but he just moans. Which of the following is the most appropriate
next step in management?
a. Prepare for intubation
b. Suture repair of head laceration
c. Administer mannitol
d. Bilateral burr holes
e. Neurosurgical intervention
138.A 74-year-old man presents to the ED after being involved in a motor
vehicle collision. He states he was wearing his seat belt in the driver’s seat
when a car hit him from behind. He thinks his chest hit the steering wheel
and now complains of pain with breathing. His RR is 20 breaths per minute,
oxygen saturation is 98% on room air, BP is 145/75 mm Hg, and HR is
90 beatsper minute. On examination, you notice paradoxical respirations.
Which of the following best describes a flail chest?
a. One rib with three fracture sites
b. Two adjacent ribs each with two fracture sites
c. Three adjacent ribs each with two fracture sites
d. One fractured right sided rib and one fractured left-sided rib
e. Two fractured right sided ribs and two fractured left-sided ribs
134 Emergency Medicine