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MRCS PART A > ED/Trauma > Flashcards

ED/Trauma Flashcards

1
Q

GCS

A

E 4
V 5
M 6

4 - Eye-opening spontaneously
3 - Eye-opening to sound
2 - Eye-opening to pain
1 - No response

5 - Orientated
4 - Confused conversation
3 - Inappropriate words
2 - Incomprehensible sounds

6 - Obeys command
5 - Localises to pain
4 - Withdraws to pain
3 - Flexion decorticate posture
2 - Abnormal extension decerebrate posture
1 - No response
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2
Q

Preferred method of haemorrhage control in external haemorrhage

A

Packing

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3
Q

Haemothorax caused by laceration to which vessel commonly?

A

intercostal vessel/internal mammary artery

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4
Q

When is surgical exploration/thoracotomy warranted in haemothorax?

A

> 1500mL blood drained immediately on chest drain

ongoing losses of >200mL/hour for >2 hours

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5
Q

Mediastinal traversing wounds Ix

A

CT angiogram

oesophageal contrast swallow

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6
Q

Diaphragmatic injury is normally on which side?

A

Left side

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7
Q

Scoring system used for ACS + purpose

A

GRACE

calculates predicted 6 month mortality

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8
Q

Aortic dissection pathology

A

tear in intimal layer

formation and propagation of subintimal haematoma

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9
Q

Most common site of aortic dissection

A

90% occurs within 10cm of aortic valve

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10
Q

Stanford A dissection location

A

ascending aorta/aortic root

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11
Q

Stanford B dissection location

A

descending aorta

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12
Q

DeBakey I dissection location

A

ascending aorta/aortic arch/descending aorta

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13
Q

DeBakey II dissection location

A

ascending aorta only

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14
Q

DeBakey III dissection location

A

descending aorta distal to left subclavian artery

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15
Q

Hyponatraemia after head injury most likely to be due to

A

SIADH

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16
Q

NEXUS criteria

A 
Full spine immobilisation if:
GCS <15
neck pain/tenderness
paraesthesia in extremities
focal neurological deficit
suspected C spine injury
17
Q

Immediate CT head within 1 hour if (7):

A 
GCS <13
GCS <15 2h after admission
suspected open/depressed skull fracture
suspected skull base fracture
focal neurology
vomiting >1 episode
post traumatic seizure
coagulopathy
18
Q

Indications for hemicraniotomy (4):

A

age <60
clinical deficit in MCA territory
decreased GCS
>50% territory infarct

19
Q

ECG changes for thrombolysis or percutaneous intervention

A

ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR

ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR

New Left bundle branch block

20
Q

Criteria for immediate request for CT scan of the head (children) (12)

A

Loss of consciousness lasting more than 5 minutes (witnessed)
Amnesia (antegrade or retrograde) lasting more than 5 minutes
Abnormal drowsiness
Three or more discrete episodes of vomiting
Clinical suspicion of non-accidental injury
Post-traumatic seizure but no history of epilepsy
GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department
Suspicion of open or depressed skull injury or tense fontanelle
Any sign of basal skull fracture (haemotympanum, panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
Focal neurological deficit
If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 m, high-speed injury from a projectile or an object)

21
Q

Pregnant patient with trauma - which position should they be placed in?

A

Left lateral decubitus

Displaced uterus from vena cava to reduce compression and increase venous return

22
Q

ATLS formula for burns resuscitation

A

2ml x wt x TBSA
half in first 8h
half in next 16h

23
Q

Wallace’s rule of nines

A 
front + back of the head and neck = 9% 
front + back of each arm and hand = 9% 
chest = 9%  
abdomen = 9%
upper back = 9% 
lower back = 9% 
front + back of each leg and foot = 18% 
genital area = 1%
24
Q

Which hormones are elevated following trauma?

A

ADH, catecholamines and corticosteroids

25
Q

When to mobilise patients post op NOF # repair

A

Day 1 post op

26
Q

Causes of increased anion gap acidosis

A 
MUDPILES
Methanol
Uraemia
DKA
Propylene glycol/paraldehyde
Isoniazid/iron
Lactic acidosis
Ethylene glycol
Salicylates
27
Q

Causes of normal anion gap acidosis

A 
HARDUP
Hyperventilation/hyperalimentation
Acetazolamidde
Renal tubular acidosis
Diarrhoea
Ureteral diversion
Pancreatic fistula/parenteral saline
28
Q

Causes of decreased anion gap

A 
Hypoalbuminaemia
Haemorrhage
Nephrotic syndrome
Intestinal obstruction
Liver cirrhosis
29
Q

Cerebral perfusion pressure

A

MAP (diastolic + 0.33333[systolic-diastolic]) - intracranial pressure

MRCS PART A (18 decks)

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