Scenario
A distressed 60 year old man from a nursing home is brought into the ED having ‘choked on his dentures’.
Question
a. Describe the CXR findings. (50%) b. What further investigations may be indicated in this man? (50%)
Answer
FACEM VAQ Exam 2003.2 – Question 4
- Overall pass rate for this question was 57 / 82 (69.5%)
- A CXR showing dentures overlying the mediastinum with probable air in the neck soft tissues.
- The examiners felt that this was an extremely good question that tested candidates’ diagnostic ability, perception, common sense and knowledge.
- Nevertheless it could be passed largely by considering the possibility of oesophageal perforation due to a foreign body.
- Common errors included not considering oesophageal perforation, indicating tracheal perforation more likely, thinking the denture wires to be sternotomy wires, use of barium in diagnostic studies and failure to include a preoperative workup in investigations.
About Mike Cadogan
