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ABPS Urgent Care study materials
ABPS Urgent Care study resources

ABPS Urgent Care practice questions

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Question 1Acute Illness and Injury Management in Ambulatory Patients

A 4-year-old has 3 days of ear pain with a bulging, opaque tympanic membrane and reduced mobility. He has no antibiotic allergy and has taken no antibiotics in the past 30 days. Which is the most appropriate first-line oral antibiotic?

  1. Ciprofloxacin suspension
  2. Trimethoprim-sulfamethoxazole
  3. Azithromycin
  4. High-dose amoxicillin Correct answer.

Explanation

High-dose amoxicillin (80–90 mg/kg/day in two divided doses) is first-line for acute otitis media in children without recent antibiotic exposure or penicillin allergy because it covers Streptococcus pneumoniae, including most penicillin-nonsusceptible strains. Macrolides and sulfonamides are avoided initially because of high pneumococcal resistance rates.

Question 2Acute Illness and Injury Management in Ambulatory Patients

Which finding favors group A streptococcal pharyngitis over a viral cause?

  1. Rhinorrhea
  2. Cough
  3. Hoarseness
  4. Tonsillar exudates Correct answer.

Explanation

Tonsillar exudates are one of the Centor/McIsaac criteria that raise the probability of group A streptococcal pharyngitis. Cough, rhinorrhea, hoarseness, and conjunctivitis are viral features that lower the likelihood of streptococcal infection.

Question 3Acute Illness and Injury Management in Ambulatory Patients

A healthy adult has 2 days of unilateral purulent discharge, matted lashes, and mild conjunctival injection without photophobia or vision change. Which is the most appropriate initial management?

  1. Immediate ophthalmology referral
  2. Oral azithromycin
  3. Topical antibiotic drops Correct answer.
  4. Topical corticosteroid drops

Explanation

Acute bacterial conjunctivitis in a healthy patient is usually self-limited and is managed with topical antibiotic drops plus lid hygiene, with erythromycin ointment as an alternative. Referral is reserved for severe pain, vision loss, photophobia, or corneal involvement.

Question 4Acute Illness and Injury Management in Ambulatory Patients

An immunocompetent adult has a fluctuant 3-cm cutaneous abscess with mild surrounding cellulitis. Which is the primary treatment?

  1. Incision and drainage Correct answer.
  2. Warm compresses alone
  3. Topical mupirocin
  4. Oral cephalexin alone for 10 days

Explanation

Incision and drainage is the definitive therapy for a fluctuant abscess, since antibiotics alone penetrate the pus collection poorly. Systemic antibiotics are added when there is extensive cellulitis, systemic signs of infection, or immunosuppression.

Question 5Acute Illness and Injury Management in Ambulatory Patients

What is the correct adult intramuscular epinephrine dose for anaphylaxis?

  1. 0.1 mg of 1:1000 IM
  2. 3 to 5 mg of 1:1000 IM
  3. 0.3 to 0.5 mg of 1:10,000 IV
  4. 0.3 to 0.5 mg of 1:1000 IM Correct answer.

Explanation

Anaphylaxis is treated with 0.3–0.5 mg of the 1:1000 concentration given intramuscularly into the anterolateral thigh, repeated every 5–15 minutes as needed. The 1:10,000 dilution is reserved for carefully titrated intravenous use in a monitored setting.

Question 6Acute Illness and Injury Management in Ambulatory Patients

Which medication is first-line for rapid relief of bronchospasm in an acute asthma exacerbation?

  1. Oral montelukast
  2. Inhaled salmeterol
  3. Intravenous aminophylline
  4. Inhaled albuterol Correct answer.

Explanation

Inhaled short-acting beta-2 agonists such as albuterol are first-line therapy because they produce rapid bronchodilation with a wide safety margin. Long-acting agents and leukotriene modifiers are maintenance therapies and are inappropriate for acute rescue.

Question 7Acute Illness and Injury Management in Ambulatory Patients

An adult with anterior epistaxis continues to bleed after 10 minutes of firm continuous nasal pressure. What is the next best step?

  1. Immediate blood transfusion
  2. Emergent otolaryngology consult for posterior packing
  3. Oral tranexamic acid followed by observation
  4. Topical vasoconstrictor with cautery Correct answer.

Explanation

Persistent anterior epistaxis after adequate direct pressure is managed by topical vasoconstriction (such as oxymetazoline) followed by cautery of a visible vessel or anterior nasal packing. Posterior packing and specialist consultation are reserved for bleeding that fails these measures.

Question 8Acute Illness and Injury Management in Ambulatory Patients

Which fluid is preferred for oral rehydration in a child with acute gastroenteritis and mild dehydration?

  1. Apple juice diluted with water
  2. Sports drink
  3. Plain water
  4. Oral rehydration solution Correct answer.

Explanation

Commercial oral rehydration solution has a balanced glucose-to-sodium ratio that drives coupled sodium and water absorption. Juice, sports drinks, and plain water have inadequate or excessive osmolarity and electrolyte content.

Question 9Acute Illness and Injury Management in Ambulatory Patients

Which presentation supports a diagnosis of acute bacterial rhinosinusitis?

  1. Clear rhinorrhea with sneezing for 3 days
  2. Symptoms lasting beyond 10 days Correct answer.
  3. Symptoms improving after 5 days
  4. Frontal headache relieved by ibuprofen

Explanation

Bacterial rhinosinusitis is suggested by symptoms persisting longer than 10 days without improvement, a severe onset with high fever and purulent discharge for 3–4 days, or initial improvement followed by worsening. Short courses with clear rhinorrhea suggest viral illness.

Question 10Acute Illness and Injury Management in Ambulatory Patients

A healthy adult has nonpurulent cellulitis of the lower leg with no abscess, no penetrating trauma, and no systemic toxicity. Which antibiotic is most appropriate?

  1. Cephalexin Correct answer.
  2. Doxycycline alone
  3. Trimethoprim-sulfamethoxazole alone
  4. Clindamycin plus trimethoprim-sulfamethoxazole

Explanation

Nonpurulent cellulitis is usually caused by beta-hemolytic streptococci, so a beta-lactam such as cephalexin is the preferred agent. MRSA-directed therapy is added for purulent infection, abscess, penetrating trauma, injection drug use, or systemic toxicity.

Question 11Acute Illness and Injury Management in Ambulatory Patients

Which finding in an ankle injury meets the Ottawa ankle rules for obtaining radiographs?

  1. Fifth metatarsal base tenderness Correct answer.
  2. Ability to walk four steps without pain
  3. Pain with active ankle range of motion
  4. Swelling over the lateral ankle

Explanation

The Ottawa ankle rules call for imaging when there is malleolar-zone pain plus bone tenderness at the posterior edge or tip of either malleolus or at the base of the fifth metatarsal or navicular, or an inability to bear weight for four steps. Swelling and motion pain alone do not meet criteria.

Question 12Acute Illness and Injury Management in Ambulatory Patients

A patient fell on an outstretched hand and has anatomic snuffbox tenderness, but initial radiographs are normal. What is the most appropriate management?

  1. Thumb spica splint with repeat films Correct answer.
  2. Reassurance with NSAIDs and return as needed
  3. Immediate open reduction and fixation
  4. Compression wrap and early range of motion

Explanation

Snuffbox tenderness with normal initial films warrants immobilization in a thumb spica splint and repeat imaging in 7–14 days because occult scaphoid fractures risk nonunion and avascular necrosis. Advanced imaging such as MRI can shorten the observation period when available.

Question 13Acute Illness and Injury Management in Ambulatory Patients

Which management is appropriate for a small traumatic corneal abrasion in an otherwise healthy adult?

  1. Topical antibiotic ointment Correct answer.
  2. Pressure patch plus topical anesthetic for 24 hours
  3. Topical corticosteroid drops four times daily
  4. Same-day ophthalmology referral for all abrasions

Explanation

Simple corneal abrasions heal well with prophylactic topical antibiotic ointment or drops and follow-up. Pressure patching is no longer recommended, and topical anesthetics are toxic to the corneal epithelium.

Question 14Acute Illness and Injury Management in Ambulatory Patients

Antiviral therapy for uncomplicated herpes zoster in an older adult is most effective when started within what timeframe?

  1. Within 7 days of rash onset
  2. Within 24 hours of the prodrome
  3. Within 72 hours of rash onset Correct answer.
  4. Only after lesions have crusted

Explanation

Antivirals for herpes zoster are most effective when begun within 72 hours of rash onset and are indicated for patients over 50, immunocompromised patients, and those with severe or ophthalmic involvement. Treatment beyond that window may still be considered in selected high-risk patients.

Question 15Acute Illness and Injury Management in Ambulatory Patients

Which bedside maneuver is used to diagnose posterior canal benign paroxysmal positional vertigo?

  1. Head impulse test
  2. Dix-Hallpike maneuver Correct answer.
  3. Electronystagmography with caloric testing
  4. Romberg test

Explanation

The Dix-Hallpike maneuver provokes characteristic upbeating torsional nystagmus with vertigo in posterior canal BPPV and is the diagnostic test of choice. The Epley maneuver is the matching repositioning treatment.

Question 16Acute Illness and Injury Management in Ambulatory Patients

A healthy adult sustains a deep puncture wound on the hand from a dog bite. Which prophylactic antibiotic is most appropriate?

  1. Azithromycin
  2. Amoxicillin-clavulanate Correct answer.
  3. Cephalexin
  4. Trimethoprim-sulfamethoxazole

Explanation

Dog and cat bites are polymicrobial, and amoxicillin-clavulanate covers Pasteurella species, streptococci, and oral anaerobes. Prophylaxis is recommended for hand bites, deep punctures, immunocompromised hosts, and bites presenting late.

Question 17Acute Illness and Injury Management in Ambulatory Patients

Which regimen is first-line for uncomplicated cystitis in a healthy, nonpregnant woman?

  1. Amoxicillin for 10 days
  2. Nitrofurantoin for 5 days Correct answer.
  3. Doxycycline for 7 days
  4. Ciprofloxacin for 7 days

Explanation

Nitrofurantoin for 5 days is a first-line option for uncomplicated cystitis because it achieves high bladder concentrations with minimal collateral resistance. Fluoroquinolones are reserved for more serious infection because of resistance and adverse effects.

Question 18Acute Illness and Injury Management in Ambulatory Patients

Which finding in suspected renal colic requires immediate emergency department referral?

  1. Nausea with a single episode of vomiting
  2. Colicky flank pain radiating to the groin
  3. Fever with an obstructing stone Correct answer.
  4. Microscopic hematuria on urinalysis

Explanation

An obstructing stone with fever suggests an infected obstructed system, a urologic emergency that requires urgent decompression and emergency evaluation. Colicky pain, vomiting, and microscopic hematuria are expected features of uncomplicated colic.

Question 19Acute Illness and Injury Management in Ambulatory Patients

Which finding in a patient with acute low back pain requires urgent evaluation?

  1. Pain relieved by lying supine
  2. Pain worsened by movement
  3. Saddle anesthesia with urinary retention Correct answer.
  4. Unilateral paraspinal tenderness

Explanation

Saddle anesthesia, new urinary retention or incontinence, and bilateral leg weakness suggest cauda equina syndrome and require emergency MRI with neurosurgical consultation. Mechanical pain patterns and focal paraspinal tenderness do not call for urgent imaging.

Question 20Acute Illness and Injury Management in Ambulatory Patients

A patient has a contaminated laceration and an unknown tetanus immunization history. What prophylaxis is indicated?

  1. Tetanus immune globulin alone
  2. Tdap vaccine alone
  3. Tdap plus tetanus immune globulin Correct answer.
  4. No prophylaxis is needed

Explanation

A contaminated wound with unknown or incomplete tetanus history requires both a tetanus toxoid-containing vaccine and tetanus immune globulin. Immune globulin is unnecessary when a complete primary series is documented and the last booster is within 5 years for a dirty wound.

Question 21Acute Illness and Injury Management in Ambulatory Patients

A 55-year-old with recent knee surgery has sudden dyspnea, pleuritic chest pain, and a heart rate of 112 beats per minute. Which next step is most appropriate?

  1. Oral rivaroxaban with outpatient follow-up
  2. D-dimer testing with discharge if negative
  3. Chest radiograph and 2-hour observation
  4. Emergency transfer for CT angiography Correct answer.

Explanation

High clinical probability of pulmonary embolism after recent surgery warrants urgent transfer for definitive imaging such as CT pulmonary angiography. A negative D-dimer cannot exclude pulmonary embolism when pretest probability is high, and empiric anticoagulation without imaging at an urgent care center is unsafe.

Question 22Acute Illness and Injury Management in Ambulatory Patients

A 60-year-old man has 20 minutes of crushing chest pain with diaphoresis, and his ECG shows ST elevation in leads II, III, and aVF. What is the most appropriate action?

  1. Nitroglycerin and reassess in 30 minutes
  2. Sublingual nitroglycerin and next-day follow-up
  3. Activate EMS for emergent reperfusion Correct answer.
  4. Troponin testing before any disposition

Explanation

ST elevation with ongoing ischemic symptoms defines a STEMI and requires immediate activation of emergency services for reperfusion. Urgent care centers should not delay transfer for troponin results or attempt outpatient management.

Question 23Acute Illness and Injury Management in Ambulatory Patients

A 3-year-old fell from a low couch with no loss of consciousness and no vomiting and is now alert and playful with a small frontal scalp hematoma. Which management is most appropriate?

  1. Skull radiographs to screen for fracture
  2. Observation with return precautions Correct answer.
  3. Immediate noncontrast head CT
  4. Admit for 24-hour neurologic observation

Explanation

A minor mechanism with no predictors of clinically important traumatic brain injury supports observation at home with clear return precautions and avoids unnecessary radiation. Loss of consciousness, vomiting, altered mental status, a severe mechanism, or a nonfrontal hematoma raise risk and prompt shared decision-making about CT.

Question 24Acute Illness and Injury Management in Ambulatory Patients

Which patient with acute pyelonephritis is a candidate for outpatient management?

  1. An elderly man with hypotension and confusion
  2. A woman tolerating oral intake Correct answer.
  3. A pregnant woman at 28 weeks' gestation
  4. A patient with sepsis and altered mentation

Explanation

Outpatient therapy for pyelonephritis is reasonable for patients who are hemodynamically stable, tolerate oral intake, and can adhere to follow-up, using an oral agent guided by culture. Pregnancy, sepsis, hemodynamic instability, and inability to take oral therapy require admission.

Question 25Acute Illness and Injury Management in Ambulatory Patients

Which burn injury meets criteria for transfer to a burn center?

  1. Superficial sunburn of both forearms
  2. Partial-thickness burn of 15% TBSA Correct answer.
  3. First-degree burn of the entire hand
  4. A 2-cm superficial abrasion on the knee

Explanation

Transfer to a burn center is indicated for partial-thickness burns exceeding 10% of total body surface area, any full-thickness burn, and partial- or full-thickness burns involving the face, hands, feet, genitalia, or major joints. Small superficial injuries can be managed in the ambulatory setting.

Question 26Acute Illness and Injury Management in Ambulatory Patients

Which antibiotic is first-line for a 4-year-old with acute otitis media and severe ear pain and fever?

  1. Trimethoprim-sulfamethoxazole
  2. Azithromycin
  3. Amoxicillin Correct answer.
  4. Ciprofloxacin

Explanation

High-dose amoxicillin is first-line for uncomplicated acute otitis media in children because it covers Streptococcus pneumoniae and is well tolerated. Severe symptoms warrant immediate antibiotic therapy rather than observation.

Question 27Acute Illness and Injury Management in Ambulatory Patients

A 24-year-old has sore throat, fever, tonsillar exudates, and tender anterior cervical nodes but no cough. According to Centor criteria, what is the most appropriate next step?

  1. Do a rapid antigen test Correct answer.
  2. Obtain blood cultures
  3. Reassure and give no testing
  4. Treat empirically with amoxicillin

Explanation

A Centor score of 4 in an adult raises the probability of group A streptococcal pharyngitis. Guidelines recommend rapid antigen testing or culture before starting antibiotics, rather than empiric treatment.

Question 28Acute Illness and Injury Management in Ambulatory Patients

Oseltamivir for influenza is most effective when initiated within how long after symptom onset?

  1. Within 12 hours
  2. Within 7 days
  3. Within 48 hours Correct answer.
  4. Within 24 hours

Explanation

Antiviral therapy for influenza is most beneficial when started within 48 hours of symptom onset, because viral replication peaks early. Later initiation may still be considered in severe or high-risk illness but is less effective.

Question 29Acute Illness and Injury Management in Ambulatory Patients

A 58-year-old with community-acquired pneumonia is alert, has a blood pressure of 118/70 mm Hg, respiratory rate of 20/min, and blood urea nitrogen of 12 mg/dL. Which setting of care is most appropriate?

  1. Discharge without antibiotics
  2. Admit to a general medical ward
  3. Admit to intensive care
  4. Treat as an outpatient Correct answer.

Explanation

This patient has a CURB-65 score of 0 because there is no confusion, uremia, tachypnea, hypotension, or advanced age. Low-risk patients with community-acquired pneumonia can usually be managed as outpatients with oral antibiotics.

Question 30Acute Illness and Injury Management in Ambulatory Patients

A healthy adult has a fluctuant, tender skin abscess with surrounding erythema but no systemic symptoms. What is the primary treatment?

  1. Warm compresses only
  2. Incision and drainage Correct answer.
  3. Topical mupirocin
  4. Oral cephalexin alone

Explanation

Incision and drainage is the primary treatment for a cutaneous abscess; antibiotics alone do not reliably drain the pus. Antibiotics may be added for systemic symptoms, extensive cellulitis, or high-risk hosts.

Question 31Acute Illness and Injury Management in Ambulatory Patients

A patient develops urticaria, wheezing, and hypotension minutes after a bee sting. Which medication should be given first?

  1. Intravenous methylprednisolone
  2. Nebulized albuterol
  3. Oral diphenhydramine
  4. Intramuscular epinephrine Correct answer.

Explanation

Intramuscular epinephrine is first-line for anaphylaxis because it rapidly reverses vasodilation and airway edema. Antihistamines, steroids, and bronchodilators are adjuncts and do not replace epinephrine.

Question 32Acute Illness and Injury Management in Ambulatory Patients

A 52-year-old man has sudden severe pain and swelling of the first metatarsophalangeal joint with no trauma. Which medication is appropriate for an acute gout flare in a patient with normal renal function?

  1. Aspirin at analgesic doses
  2. Probenecid
  3. Naproxen Correct answer.
  4. Allopurinol during the flare only

Explanation

NSAIDs such as naproxen are first-line for acute gout in patients without contraindications. Aspirin at analgesic doses can raise urate levels, and urate-lowering drugs are not used alone for acute symptom control.

Question 33Acute Illness and Injury Management in Ambulatory Patients

A 29-year-old woman has recurrent migraine with nausea and photophobia. She has no vascular disease and is not pregnant. Which medication is appropriate for acute migraine treatment?

  1. Isometheptene
  2. Atenolol
  3. Ergotamine
  4. Sumatriptan Correct answer.

Explanation

A triptan such as sumatriptan is first-line for moderate to severe acute migraine in patients without contraindications. It is contraindicated in pregnancy, uncontrolled hypertension, and known coronary or cerebrovascular disease.

Question 34Acute Illness and Injury Management in Ambulatory Patients

A 10-year-old has bilateral watery eye discharge, a red eye, and a recent upper respiratory infection. Vision is normal. What is the most appropriate management?

  1. Urgent referral
  2. Cool compresses Correct answer.
  3. Steroid drops
  4. Antibiotic drops

Explanation

Bilateral watery discharge with a recent upper respiratory infection and normal vision suggests viral conjunctivitis, which is self-limited and treated supportively. Antibiotic drops are not indicated for viral conjunctivitis and may cause irritation or resistance.

Question 35Acute Illness and Injury Management in Ambulatory Patients

A 3-year-old refuses to use the left arm after being pulled by the hand. The arm is held pronated and slightly flexed, and there is no swelling or focal bony tenderness. What is the most appropriate next step?

  1. Place a long arm cast
  2. Obtain radiographs of the shoulder
  3. Start oral antibiotics
  4. Supination-flexion reduction Correct answer.

Explanation

The presentation is classic for radial head subluxation, also called nursemaid's elbow, which is diagnosed clinically and treated with a supination-flexion maneuver. Radiographs are unnecessary when the history and examination are typical.

Question 36Acute Illness and Injury Management in Ambulatory Patients

A 2-year-old has a barking cough, inspiratory stridor, and hoarse voice but no drooling or severe distress. What is the most appropriate initial treatment?

  1. Racemic epinephrine alone
  2. Nebulized albuterol
  3. Dexamethasone Correct answer.
  4. Oral antibiotics

Explanation

Croup is treated with a single dose of dexamethasone, which reduces airway edema and symptom duration. Racemic epinephrine is reserved for moderate to severe distress and should be combined with steroid therapy.

Question 37Acute Illness and Injury Management in Ambulatory Patients

A patient removed an engorged tick from the forearm 2 days ago and has no symptoms. The tick was attached for less than 24 hours in an area with low Lyme disease prevalence. What is the appropriate management?

  1. Start doxycycline prophylaxis
  2. Give amoxicillin for 10 days
  3. Observe and give no antibiotics Correct answer.
  4. Obtain acute and convalescent serology

Explanation

Antibiotic prophylaxis after a tick bite is not routinely recommended when the tick was attached for less than 24 hours, especially in a low-prevalence area. Serology is not useful immediately after a bite, and asymptomatic patients do not need treatment.

Question 38Acute Illness and Injury Management in Ambulatory Patients

A 16-year-old presents with sudden severe testicular pain, nausea, and an elevated testicle on the left. Which action is most important?

  1. Obtain a urine culture and await results
  2. Immediate urologic evaluation for detorsion Correct answer.
  3. Treat with oral antibiotics for epididymitis
  4. Apply a scrotal support and discharge

Explanation

Sudden severe testicular pain with nausea and a high-riding testicle suggests testicular torsion, a surgical emergency. Immediate urologic evaluation is required because salvage declines sharply after 6 hours.

Question 39Acute Illness and Injury Management in Ambulatory Patients

A 45-year-old reports sudden left-sided hearing loss and tinnitus that began 2 days ago. The ear canal and tympanic membrane appear normal. What is the most appropriate management?

  1. Prescribe oral antibiotics
  2. Perform ear irrigation
  3. Urgent steroids and referral Correct answer.
  4. Reassurance and follow-up in 2 weeks

Explanation

Sudden sensorineural hearing loss is an otologic emergency; prompt corticosteroids improve the chance of hearing recovery. It should be referred urgently for audiometry and specialized care.

Question 40Acute Illness and Injury Management in Ambulatory Patients

An older adult develops severe eye pain, blurred vision, and halos around lights, and the eye is red with a fixed mid-dilated pupil. What is the most appropriate immediate action?

  1. Patch the eye and observe
  2. Prescribe antibiotic eye drops
  3. Emergent ophthalmology referral Correct answer.
  4. Schedule routine optometry follow-up

Explanation

Severe pain, halos, blurred vision, and a fixed mid-dilated pupil suggest acute angle-closure glaucoma, which can cause permanent vision loss within hours. Emergent ophthalmologic treatment is required to lower intraocular pressure.

Question 41Procedures, Wound Care, and Minor Surgical Skills

What irrigation pressure is recommended for a contaminated wound to remove debris without causing tissue damage?

  1. 40 to 50 psi
  2. 1 to 2 psi
  3. 8 to 12 psi Correct answer.
  4. 20 to 25 psi

Explanation

Irrigation at 8 to 12 psi is effective for removing debris and bacteria from contaminated wounds while limiting tissue injury. Lower pressures do not adequately cleanse the wound, and substantially higher pressures can drive contaminants deeper and damage tissue.

Question 42Procedures, Wound Care, and Minor Surgical Skills

When should sutures typically be removed from a simple facial laceration in an adult?

  1. 10 days
  2. 5 days Correct answer.
  3. 3 days
  4. 14 days

Explanation

Facial wounds heal relatively quickly because of rich blood supply, so sutures are usually removed after about 5 days. Leaving them longer increases the risk of suture marks, while removing them too early risks wound dehiscence.

Question 43Procedures, Wound Care, and Minor Surgical Skills

What is the maximum recommended dose of lidocaine with epinephrine for a 70 kg adult?

  1. 5 mg/kg
  2. 10 mg/kg
  3. 3 mg/kg
  4. 7 mg/kg Correct answer.

Explanation

Lidocaine with epinephrine may be dosed up to 7 mg/kg in adults, which provides prolonged anesthesia and reduced bleeding. Exceeding this limit increases the risk of local anesthetic systemic toxicity.

Question 44Procedures, Wound Care, and Minor Surgical Skills

Which technique is appropriate for achieving digital anesthesia before repairing a fingertip laceration?

  1. Inject anesthetic into the flexor tendon sheath
  2. Apply topical anesthetic to the nail bed
  3. Infiltrate only the dorsal skin at the fingertip
  4. Perform a ring block at the base of the digit Correct answer.

Explanation

A digital ring block anesthetizes the digital nerves at the base of the digit and provides reliable anesthesia for fingertip procedures. Injecting into the tendon sheath or relying on topical anesthetic alone does not reliably anesthetize the digit.

Question 45Procedures, Wound Care, and Minor Surgical Skills

Which step is most appropriate during incision and drainage of a cutaneous abscess?

  1. Tight packing of every abscess cavity
  2. Incision over the point of maximal fluctuance Correct answer.
  3. Incision through the center of necrosis
  4. Aggressive curettage of the cavity

Explanation

The incision should be made over the area of maximal fluctuance to enter the abscess cavity directly and allow drainage. Aggressive curettage and routine tight packing are not required and may increase pain or harm tissue.

Question 46Procedures, Wound Care, and Minor Surgical Skills

A patient has a painful subungual hematoma involving more than half of the nail, and the nail is intact. What is the most appropriate management?

  1. Oral antibiotics
  2. Application of a splint
  3. Complete nail removal
  4. Trephination of the nail Correct answer.

Explanation

Trephination allows drainage of the hematoma and relief of pressure while preserving the nail. Complete nail removal is reserved for more complex injuries, and antibiotics are not indicated for an uninfected hematoma.

Question 47Procedures, Wound Care, and Minor Surgical Skills

Which technique is appropriate for removing a fishhook embedded in the skin when the barb is not visible?

  1. Cut the eye and pull the hook through
  2. Advance the hook through the skin and cut the barb Correct answer.
  3. Push the hook deeper and leave it
  4. Pull the hook backward without advancing

Explanation

Advancing the hook through the skin exposes the barb so it can be cut off, allowing the hook to be withdrawn without tearing tissue. Pulling backward against an embedded barb causes further tissue injury.

Question 48Procedures, Wound Care, and Minor Surgical Skills

A live insect is lodged in a patient's ear canal. What is the appropriate first step before removal?

  1. Immediately irrigate with saline
  2. Grasp the insect with forceps
  3. Leave it and recheck in 24 hours
  4. Kill the insect with lidocaine before removal Correct answer.

Explanation

Killing the insect first prevents it from moving and damaging the canal or tympanic membrane during removal. Irrigation and blind forceps attempts on a live insect can worsen the injury.

Question 49Procedures, Wound Care, and Minor Surgical Skills

A patient has persistent anterior epistaxis after 10 minutes of direct pressure, and no bleeding site is visible. What is the most appropriate next step?

  1. Posterior nasal packing
  2. Anterior nasal packing Correct answer.
  3. Immediate nasal surgery
  4. Intravenous tranexamic acid

Explanation

Anterior nasal packing is appropriate when direct pressure fails and no discrete bleeding point can be cauterized. Posterior packing is reserved for suspected posterior bleeding, which is less common and carries greater risk.

Question 50Procedures, Wound Care, and Minor Surgical Skills

Using the adult rule of nines, what percentage of total body surface area is represented by an entire left arm?

  1. 1%
  2. 18%
  3. 9% Correct answer.
  4. 4.5%

Explanation

In the adult rule of nines, each entire arm represents 9% of total body surface area. The 18% figure would represent both arms together.