Trauma

Question 1

Cushing’s reflex

Answer 1

**Signs of ICP

1. HTN
2. bradycardia
3. Irregular respiratory pattern

Question 2

Most important factor for neuro assessment in head trauma

Answer 2

level of consciousness

Question 3

Most common cause of traumatic brain injury?

Answer 3

motor vehicle collision

Question 4

Best treatment for decreasing ICP?

Answer 4

mannitol (osmotic diuretic)

Question 5

What are key findings on a blowout fracture exam?

Answer 5

• enopthalmos
• Limited upward gaze
• Diplopia with upward gazev
• Loss of sensation below the orbit

Question 6

What should you do with a patient with a blowout fracture?

Answer 6

• Emergent referral for ENT surgery
• Antibiotics (ex. amoxicillin-clauvulanate, levofloxicin)
• Tetanus prophylaxis

Question 7

What should you look for on xray for a possible blow out fracture?

Answer 7

Tear drop sign on Water’s view*

Question 8

What is the first and second most commonly fractured facial bones?

Answer 8

1. Nose

2. Mandible

Question 9

Central Cord Syndrome

Answer 9

• Hyperextension injury
• Arm weakness
• Bladder dysfunction

Question 10

Anterior cord syndrome

Answer 10

• Complete motor paralysis and loss of pain and temperature sensation distal to lesion
• Preserved light touch, motion, vibration, and proprioception

Question 11

Brown-Sequard

Answer 11

• one-sided cord injury
• Same side: loss of voluntary motor
• Opposite side: loss of temperature and pain sensation

Question 12

Spinal injuries fro most severe to least severe

Answer 12

1. Flexion teardrop
2. Extension teardrop
3. Hangman’s
4. Jefferson
5. Clay shoveler’s

Question 13

Flexion Teardrop: MOI

Answer 13

• Diving injury

- Sudden forceful flexion

Question 14

Jefferson Fracture: MOI

Answer 14

C1 burst fracture

-Vertical compressive force

Question 15

Hangman’s Fracture: MOI

Answer 15

C2 pedicle fracture

-Hyperextension injury

Question 16

Clay shoveler’s Fracture

Answer 16

Avulsion fracture of spinous process fo C6-T1

-Flexion injury

Question 17

Where is the most common location of a wedge or compression fracture?

Answer 17

L1, then L2, then T12

unlikely to have neurologic effects

Question 18

Chance Fracture

Answer 18

• bone splits horizontally through spinous process, laminae, pedicles, vertebral body
• “owl eyes”**
• associated with intra-abdominal injuries

Question 19

Spinal Trauma: treatment

Answer 19

1. Inline immobiliation/stabilization
2. Sellick’s Maneuver for intubation
3. 4 person log roll for emesis

Question 20

Which of the zones of neck trauma need angiography?

Answer 20

Zone 1 - below the cricoid cartilage

Zone 2 - above the angle of the mandible

Question 21

Is a pneumothorax seen best on expiratory or inspiratory view?

Answer 21

expiratory

Question 22

Flail chest

Answer 22

3 ribs, each broken in two places

• inward motion during inspiration
• outward during expiration

Question 23

Most common cause of hypoxia in flail chest

Answer 23

lung contusion

Question 24

How is pulmonary contusion diagnosed?

Answer 24

pulmonary opacity seen within 6 hours of blunt trauma

Question 25

What will pneumothorax look like on US?

Answer 25

barcode

Question 26

What is normal lung look like on US?

Answer 26

seashore sign

Question 27

Where is a chest tube placed for a pneumothorax?

Answer 27

5th intercostal space Above the rib (to avoid neurovascular bundle) midaxillary line

Question 28

Hamman's crunch

Answer 28

crunching sound heard over the heart during systole if subcutaneous emphysema in neck (be suspicious)

Question 29

Beck's triad

Answer 29

Cardiac tamponade 1. JVD 2. muffled heart sounds 3. Hypotension

Question 30

Cardiac tamponade: classic signs

Answer 30

- Beck's Triad - pulsus paradoxus - Kussmaul sign - neck veins pop out with taking a breath - Electrical alternans - shortened QRS

Question 31

What fracture is most significantly associated with myocardial contusion

Answer 31

sternum fracture

Question 32

Traumatic rupture of aorta most commonly involves what?

Answer 32

aortic isthmus (between left subclavian and ligamentous arteriosum)

Question 33

What is the most common complaint of someone with traumatic rupture of the aorta?

Answer 33

retrosternal or interscapular pain made worse when BP increases

Question 34

What is the key finding for traumatic rupture of the aorta?

Answer 34

Difference in pulse amplitude between UE and LE

Question 35

Aorta rupture CXR findings

Answer 35

1. Mediastinal widening 2. Esophagus deviation to the right*** 3. Blurring aortic knob 4. Tracheal deviation to the right 5. Left pleural effusion

Question 36

Most common organ injured in penetrating trauma is _____

Answer 36

liver

Question 37

Most common organ injured in blunt trauma is _____

Answer 37

spleen

Question 38

What type of injury should you assume if patient has trauma and is hypotensive?

Answer 38

Abdominal injury

Question 39

Kehr's Sign

Answer 39

Left shoulder pain classically associated with splenic rupture

Question 40

Best radiographic study for abdominal trauma?

Answer 40

CT

Question 41

What is the name for the most posterior portion on the right side between the liver and the kidney?

Answer 41

Morrison's Pouch