Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didnt want to go to the emergency room because he didnt want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes

Correct Answer: C

Rationale: The correct answer is C: Local anesthesia, cleansing, and suture repair. 1. Local anesthesia is needed to minimize pain during the procedure. 2. Cleansing is crucial to remove contaminants and reduce the risk of infection. 3. Suture repair is necessary for a jagged laceration of this size to promote proper wound healing and minimize scarring. Summary of other choices: A: Antibiotic therapy is not routinely needed for clean lacerations, and covering alone may not provide adequate wound closure. B: While wound exploration for foreign bodies is important, it is not the immediate priority for this patient with an open, flapping laceration. D: While cleansing, covering, and tetanus prophylaxis are important, antibiotic therapy is not routinely needed for clean lacerations.

Correct Answer: B

Rationale: The correct answer is B: Gastroesophageal reflux disease (GERD). Achalasia is a motility disorder characterized by impaired esophageal peristalsis and lower esophageal sphincter relaxation. This dysfunction can lead to stagnant food in the esophagus, causing regurgitation and increased intra-esophageal pressure, which can trigger GERD. Squamous cell carcinoma (choice A) is not directly linked to achalasia. Esophageal atrophy (choice C) is not a typical consequence of achalasia. Malabsorption syndromes (choice D) are not directly associated with achalasia.

Correct Answer: C

Rationale: The correct answer is C: Local anesthesia, cleansing, and suture repair. 1. Local anesthesia is needed to minimize pain during the procedure. 2. Cleansing is crucial to remove contaminants and reduce the risk of infection. 3. Suture repair is necessary for a jagged laceration of this size to promote proper wound healing and minimize scarring. Summary of other choices: A: Antibiotic therapy is not routinely needed for clean lacerations, and covering alone may not provide adequate wound closure. B: While wound exploration for foreign bodies is important, it is not the immediate priority for this patient with an open, flapping laceration. D: While cleansing, covering, and tetanus prophylaxis are important, antibiotic therapy is not routinely needed for clean lacerations.

Correct Answer: A

Rationale: The correct answer is A: Irritable bowel syndrome. Mrs. Maroldo's history of recurrent left lower quadrant pain that usually resolves with antibiotics suggests a chronic condition rather than an acute one like diverticulitis, appendicitis, or inflammatory bowel disease. Her lack of nausea, vomiting, and severe symptoms, along with the presence of diarrhea and no bowel movements, align more with irritable bowel syndrome. Additionally, her vital signs are not significantly elevated, ruling out acute conditions like appendicitis. Discomfort to deep palpation in the left lower quadrant is common in irritable bowel syndrome due to visceral hypersensitivity. Therefore, based on her chronic symptoms, lack of severe signs, and typical presentation, the most likely diagnosis is irritable bowel syndrome.

Correct Answer: B

Rationale: The correct answer is B: Mauriceau-Smellie-Veit. This method involves flexing the hips, extending the thighs, and applying suprapubic pressure to deliver the head in a complete breech presentation. This technique helps to avoid hyperextension of the neck and potential spinal cord injury. The Lovset maneuver (A) is used for delivering the arms in a breech presentation. The Burns Marshall method (C) involves performing an episiotomy and delivering the baby by flexion and traction on the legs. Gentle traction of the neck (D) is not recommended as it can cause spinal cord injury. Mauriceau-Smellie-Veit is the preferred method for safe delivery of the head in a complete breech presentation.

Correct Answer: C

Rationale: The correct answer is C: Chest radiography. In cases of acute abdomen, a chest radiograph is essential to rule out conditions like pneumothorax, pleural effusion, or pneumonia which may present with similar symptoms. This helps in identifying potential causes of abdominal pain outside the abdomen. Abdominal radiograph (A) may not provide enough information for diagnosis. Contrast radiography (B) and ultrasonography (D) are not universally essential for all cases of acute abdomen and may not be appropriate in certain situations.

Correct Answer: A

Rationale: The correct answer is A: HELLP syndrome. This must be evaluated as a cause of abdominal pain in a pregnant patient because it is a serious condition characterized by hemolysis, elevated liver enzymes, and low platelet count. These abnormalities can lead to abdominal pain, especially in the right upper quadrant. Placental abruption (B) presents with vaginal bleeding and uterine tenderness, not specific abdominal pain. Spontaneous hepatic rupture (C) is rare and usually presents with sudden severe abdominal pain. Preterm labor (D) typically presents with regular uterine contractions and lower abdominal discomfort, not specific upper quadrant pain like in HELLP syndrome.

Correct Answer: C

Rationale: The Mauriceau-Smellie-Veit maneuver is the correct answer for delivering the head in a breech presentation. This maneuver involves applying pressure to the fetal head with the fingers in the mouth to flex the head, guiding it through the pelvis. This technique helps prevent hyperextension of the head and facilitates a safe delivery. The Lovset maneuver involves rotating the fetus to disengage the impacted shoulder, not for delivering the head. The Burns Marshall Method is used for delivering the aftercoming head in a breech presentation. The Reverse woodscrew maneuver is a technique to disimpact a shoulder dystocia, not for delivering the head in a breech presentation.

Correct Answer: D

Rationale: The correct answer is D. A ruptured uterus can lead to fetal distress and necessitate a cesarean section. Failure of the cervix to dilate is indicative of a potential uterine rupture, as the uterus may not be able to contract effectively due to the rupture. Maternal dehydration (A), pyrexia (B), and oliguria (C) are not specific signs of a ruptured uterus and may be present in various other conditions. Therefore, failure of the cervix to dilate is the most relevant early sign in this scenario.