410C Quiz 1: sensitive exam, MSK, IV injections/fluids

Question 1

When should you release the tourniquet when taking blood?

Answer 1

after the flash, before you use the tubes

Question 2

Shoulder Joints

Answer 2

• Contains the scapula, humerus, clavicle, glenohumeral joint, acromioclavicular joint
  
  • glenohumeral is the actual shoulder joint
  • scapulothoracic joint is in the back → important for impingement injuries

Question 3

Rotator Cuff General info

Answer 3

• consists of SITS: supra spinatus, infra spinatus, teres minor, sub scapularis
  
  • impingement syndrome → most important muscle = supra spinatus muscle b/c it passes beneath the acromion

Question 4

Y view of the shoulder

Answer 4

• aka transcapular view b/c it shoots down the body of the scapula
• used to look for impingement
• gets a good look at the acromion
• used to assess the acromion

Question 5

What is the grashey view?

Answer 5

Shoulder film

no overlap of the humerus and glenoid

• Used to see the glenohumeral joint

Question 6

Xray of (lateral & AP) Elbow vs radial-capitellar view

Answer 6

• Xray Elbow:
  
  • cannot see the radial head that well
• XR Elbow Radiocapitellar View:
  
  • if suspect elbow fracture (usually a radial head fracture) → need to order a radiocapitellar view
  • better view of the radial head

Question 7

Posterior vs Anterior Fat Pads in the Elbow

Answer 7

• Anterior can be normal
• Posterior is always Pathological
  
  • indicative of a fracture

Question 8

Galeazzi Fracture vs Monteggia Fracture

Answer 8

“Gruesome Murder”

• Galeazzi: Radial fracture, ulnar dislocation (distal)
• Monteggia: Ulnar fracture, radial dislocation (proximal)

Question 9

Torus/Buckle Fracture

Answer 9

• AP of the wrist
• kids bones are covered with a very thick, fibrous periosteum
• torus, buckle, and greenstick are all the same thing
• **Only found in children → check for open growth plate

Question 10

Salter Harris Classification

Answer 10

Question 11

Pelvis Fractures

Answer 11

Super serious, major trauma!!

look for associated injuries

• anticipate large blood loss
  
  • up to 9-15 units of blood in unstable fractures
  • external and internal iliac arteries are present anterior
  • femoral artery, profunda and circumflex artery are present posterior
• tx:
  
  • admission
  • look for associated injuries → vessel/bladder/nerve/head trauma/ cervical spine injuries
  • Manage blood loss
  • often surgical
    
    • **side note: pelvis & ankle are a ring so if there is one fracture it is still stable, but two make it unstable!!!

Question 12

Garden Classification of Hip Fractures

Answer 12

Question 13

Names of Different Fractures

Answer 13

Question 14

What do you do if you see a tibial plateau fracture?

Answer 14

if both side → need CT

could be due to MVA

need neurovascular exam ASAP

check hgb & HCT asap

give blood prn

check for compartment syndrome!

Question 15

Mortise Joint

Answer 15

• the medial malleolus of the tibia forms the top of the mortise joint
• can order a mortise view -→ can see both sides
  
  • spaces in the mortise joint should be equal ~1mm
  • if there is a difference in the spaces = displaced ankle

Question 16

Lisfranc Injury

Answer 16

• VERY BAD, takes significant trauma
• Can’t miss
• usually requires surgery to repair
  
  • and often has residual issues after surgery

Question 17

Phalangeal Fractures

Answer 17

Most are not problematic except the great toe

• can often be reduced & taped
• use postop shoe or split
• great toe will often require surgery

Question 18

Jones Fracture

Answer 18

• Proximal 5’th metatarsal diaphysis fracture
• Pain over the lateral border of the forefoot, especially with weight-bearing
• The fracture is believed to occur as a result of significant adduction force to the forefoot with the ankle in plantar flexion
• The area has a poor blood supply
• Treatment: Walking boot/cast, RICE, surgery for displaced fractures. Requires 6 weeks of non-weight bearing

Question 19

What should you never do with a fresh fracture?

Answer 19

put the pt in the cast → you need to splint then refer

Question 20

What films do you need to order for a shoulder dislocation?

Answer 20

Axillary View and AP view before AND after reduction

Question 21

If pt fell on their arm in full extension what film do you need to order?

Answer 21

Grashey view

Question 22

What is the most important muscle for impingement?

Answer 22

Supraspinatus

Question 23

If pt has impingement syndrome what film do you always order & why?

Answer 23

Y film → b/c if you don’t order Y view you might not know that the acromion is a type III which requires surgery and that is why the injury isn’t resolving → not enough anatomical space for the supraspinatus tendon

Question 24

If pt comes in for a fall on their hand with positive snuffbox tenderness what film should you order and why?

Answer 24

Scaphoid view b/c this is a scaphoid fracture until proven otherwise

Question 25

What size angiocath is most appropriate for: IV maintenance fluids vs blood infusion

Answer 25

IV maintenance fluids: 20g Blood infusion: 18g

Question 26

Why do we use a saline flush on extension tubing and a saline lock?

Answer 26

ensuring extension tubing is patent prevent an air embolism

Question 27

How long should you leave the tourniquet in place?

Answer 27

no longer than 1-2 minutes at a time

Question 28

How often does the CDC recommend changing the peripheral IV site?

Answer 28

72-96 hours

Question 29

Calculating Body Water

Answer 29

* BW = 60% of body weight * ICF = ⅔ of body water * ECF = ⅓ of body water * ¾ of ECF = interstitium * ¼ of ECF = plasma

Question 30

Osmolality Definition & normal values

Answer 30

* _Definition_: * solute or particle concentration of a fluid * _Normal range_: 280-295 mOsm/kg * _Symptomatic_ when numbers are: * \>320-330 mOsm/kg or \<265 mOsm/kg

Question 31

How to calculate osmolality?

Answer 31

2x (sodium) + glucose/18 + BUN/2.8

Question 32

Conditions that cause Hypovolemia

Answer 32

Question 33

Conditions that Cause Hypervolemia

Answer 33

Question 34

Renin-Angiotensin System

Answer 34

Question 35

What is the most common maintenance fluid?

Answer 35

D5W ½ NS

Question 36

How to Tx Volume Overload

Answer 36

Question 37

IV Cath size and flow rates

Answer 37

Question 38

5% albumin vs 25% albumin

Answer 38

* if 1 liter of **5% albumin** is given, all will stay in intravascular space because its too large to cross the cell membrane * 1000mL → 1000mL * if 100mL of **25% albumin** is given, it will draw 5x its volume into the intravascular compartment * 100mL → 500mL

Question 39

Types & Cross

Answer 39

Blood is taken from the pt and typed and then crossed with a donor blood to look for agglutination/rxn * takes 45min -1 hour → so ACT EARLY! * type & cross is only good for 48-72hrs so may need a new one * how much do you ask for? 2-6 units * use O- is you cannot wait (often the case!)

Question 40

when do you give blood?

Answer 40

if Hgb of 7 without active bleed if hgb of 9-10 with active bleed

Question 41

How much increase in hgb from packed red blood cells?

Answer 41

* expect increase of **1gm/dl** in Hgb (3%) in HCT from a unit (325-350ml) of PRBCs

Question 42

When do you start adding FFP, Cryo & platelets?

Answer 42

after 4 units of packed red blood cells may be needed sooner based on findings → check fibrinogen, platelet count, ACT, INR if FFP isn't thawed it may reduce effectiveness of coagulation factors (due to the cold)

Question 43

What fluids are okay to bolus?

Answer 43

Normal Saline Normosol R Lactated Ringer's PLasma-Lyte 148

Question 44

Maintenance Fluids rates and additions

Answer 44

Question 45

Potassium Repletion Infusion Rates

Answer 45

Question 46

What is pelvic pain in a woman \< 50yo until proven otherwise?

Answer 46

ectopic pregnancy

Question 47

What does the sexual history include?

Answer 47

* Gender identity * sexual orientation * social hx * GU & Genital ROS * GYN hx → pregnancies, deliveries, menarche etc

Question 48

6 Ps of Sexual History

Answer 48

1. Partners 2. Practices 3. Protection from STIs 4. Past Hx of STIs 5. Pregnancy Intention 6. (Pleasure)