Trauma & Ortho Flashcards
(80 cards)
1
Q
In trauma, victims , life-threatening conditions are identified and corrected during the ________.
A
Primary Survey
2
Q
First priority of the primary survey in ATLS?
A
Securing the airway
3
Q
Goal of primary survey?
A
Treat conditions that constitute an immediate threat to life
4
Q
The most common cause of upper airway obstruction in an unconscious patient is?
A
The tongue falls back into the posterior pharynx
5
Q
Indications for early airway intervention ( preemptive intubation) in trauma?
A
- Penetrating injuries to the neck with an expanding hematoma.
- Evidence of chemical or thermal injury to the mouth , nares, or hypopharynx.
- Extensive subcutaneous air in the neck complex maxillofacial trauma.
- Airway bleeding
6
Q
Zone inferior to the clavicle and manubrium sterni and encompasses all structures in the thoracic outlet?
A
Zone 1
7
Q
Which of the following is a characteristic of zone I neck injury?
A
Is notorious for occult hemothorax / great vessel injury.
8
Q
Indications for exploratory laparotomy in penetrating or blunt abdominal injury!
A
- Hemodynamically instability
- Peritonitis
- Evisceration
- Positive DPL
- Persistent drop in hct
9
Q
Positive DPL finding in anterior abdominal stab wound?
A
- RBCs >100,000 /ml
- WBC >500 /ml
- Amylase >19 IU/L
4.Alkaline phosphatase >2IU/L - Bilirubin level >0.01 mg/dL
10
Q
Maximum duration of pulse checks according to the ACLS guidelines
A
10 seconds
11
Q
Required treatment for displaced femoral neck fractures in older adults due to the risk that it will disrupt the blood supply.
A
Prosthetic replacement
12
Q
Fracture of C2 pedicles
A
Hangman’s fracture
13
Q
Most common malignancy of the bone?
A
Osteosarcoma
14
Q
Which peripheral nerve is compressed in a 30yo call center agent with carpal tunnel syndrome?
A
median nerve
15
Q
Most common malignant presacral tumors?
A
Sacrococcygeal chondroma
16
Q
Fasciotomy is indicated if?
A
- Gradient pressure <30mmHg ( Diastolic P- Compartment P)
- Absolute compartment P > 30mmHg
- Ischemic periods >6hrs
- Combined arterial and venous injuries
17
Q
Life-threatening traumatic injuries?
A
- Cardiac tamponade
- Massive hemothorax
- Hemoperitoneum
- Unstable pelvic fractures
18
Q
Damage control surgery goals?
A
- Limit enteric content spillage
- Prevent blood vicious cycle
- Control bleeding
- Prevent ischemia
19
Q
Causes of bleeding after massive blood transfusion?
A
- Hypothermia
- Dilutional coagulopathy
- Fibrinolysis or Hypofibrinogenemia
- Platelet dysfunction
20
Q
Commom nerve palsy after hip arthroplasty?
A
Sciatic nerve in over 90% of cases followed by femoral nerve
21
Q
Complications of exploratory laparotomy?
A
- Infection
- Atelectasis
- Ileus
22
Q
Causes of stress related hyperglycemia in post-op patients?
A
- Glucagon
- Epinephrine
- Glucocorticoid
23
Q
Components of Glasgow Coma Scale
A
- Eye opening
- Verbal response
- Motor response
24
Q
Invasive monitoring of patients fluid status
A
CVP ( Central Venous Pressure) when a large amounts of fluids are administered
25
Anterior knee pain involving the patella and retinaculum
Patellofemoral Pain Syndrome / Runners Knee
26
Structure kyphosis affecting the lower thoracic and upper lumbar regions?
1. Gibbus deformity
2. Tuberculous spondylitis / Potts Disease
27
Characteristics of inhalation injury?
1. Increased metabolic demand
2. Cause direct mucosal and heat injury to upper airways
28
Etiology of hematemesis that will require emergency management
1. Esophageal varices
2. Endoscopy with variceal band ligation should be carried out as soon as possible
29
Diagnostic modalities for lymphedema
1. Lymphoscintigraphy
2. Duplex ultrasound
30
Depth of chest compressions in CPR?
5.6cm (2-2.4inch ) deep
31
Number of rescue breaths per cycle?
2 breaths
32
Number of chest compressions per cycle
30 compressions
33
Number of cycles rescuers should perform for CPR to be effective?
5 cycles in 2 mins
34
Indication for laparotomy in penetrating abdominal trauma?
1. Hemodynamic instability
2. Obvious peritoneal signs
3. Impaled foreign body
4. Pneumoperitoneum
5. Herniated abdominal organs
6. GSW with evidence of intraperitoneal penetration
7. Blood in orifices
35
The most commonly injured intra abdominal organ following a blunt abdominal trauma
Liver
36
Top 2 most commonly injured intra abdominal organs in blunt abdominal trauma?
Liver , Spleen
37
The order of priority in the management of a multiple injured patient is?
1. Chest & Abdomen
2. Head and Spine
3. Limb
38
In healthy patients who bleed, how many percent of the blood volume is lost for them to manifest significant changes in the vital signs?
30%
39
Which of the following traumatic abdominal injuries necessitates immediate surgical exploration?
Eviscerated omentum
40
The following are indication for performing exploratory laparotomy among abdominal trauma patients?
1. Omental evisceration
2. Hemodynamically unstable
3. Signs of peritonitis
41
Which of the following findings is consistent with disseminated intravascular coagulopathy?
1. Elevated fibrin split products
2. Thrombocytopenia
3. Low fibrinogen level
4. Prolonged prothrombin time
42
How long should a pulse check lasts?
Not more than 10 seconds
43
The most dreaded complication seen in elderly patients with displaced interthrocanteric hip fracture ?
Uncontrolled bleeding
44
The most malignancy involving bone?
Osteosarcoma
45
A 20yo basketball player tear in his anterior cruciate ligament manifested by pain and swelling is best treated with?
Arthroscopic surgery
46
Bilateral fracture of the pars interarticularis involving the C2 spine is called?
Hangman’s fracture
47
Treatment of choice for non-aligned femoral neck fracture is?
Total hip replacement
48
A fracture of the distal radius in which the distal fragment is dorsally displaced is?
Colle’s fracture
49
Inappropriate airway maneuver in managing a trauma patient with cervical spinal control ?
Head tilt
50
Most common indication for endotracheal intubation?
Altered mental status
51
Thoracostomy location in adults?
4th ICS or 5th ICS AAL
52
Definitive treatment of open pneumothorax?
Closere of the chest wall defect + closed tube thoracostomy remote from the wound
53
Definition of flial chest?
Fractures >/= 3 contiguous ribs in >/= 2 locations
54
Most appropriate treatment for pneumothorax?
Insertion of chest tube drainage of the pleural space
55
Physical exam findings of pneumothorax?
1. Shortness of breath
2. Unilateral chest pain
3. Decreased breath sounds Ipsilateral side
4. Hyperresonant on percussion of the ipsilateral side
56
Palpable pulse and corresponding approximate systolic blood pressure
1. Carotid SBP >60
2. Femoral SBP >70
3. Radial SBP >80
Up down out
57
Hard signs of vascular injury
1. Pulsatile hemorrhage
2. Absent pulses
3. Acute ischemia
Operation is mandatory if there are hard signs
58
Hemorrhage class of an anxious and confused patient with hypotension, PR 130, RR 35, and UO 10ml / hr
Class III
59
Cut off massive hemothorax in adults and children?
Adult >1,500ml
Children >25% blood volume
60
Excision of a portion of the pericardium which allows drainage of cardiac tamponade?
Subxiphoid pericardial window
61
Preferred test in the diagnosis of the cardiac tamponade?
Echocardiogram
62
Formula to compute GCS in intubated patients or if they are unable to verbalize?
GCS= E + DVS + M
DVS= (0.5M + 0.4E)
63
Signs of suspected basilar skull fracture ?
1. Battle sign ( ecchymosis behind ear)
2. Racoon eyes ( peri orbital ecchymosis)
3. CSF rhinorrhea
4. Otorrhea
64
Temporizing maneuver for patients in impending herniation while awaiting definitive surgical management that decreases cerebral blood flow?
Hyperventilation
65
6Ps of Compartment Syndrome?
1. Pain
2. Paresthesia
3. Pallor
4. Poikilothermy
5. Paralysis
6. Pulselessness
66
Distal radial fracture with volar angulation?
Smith’s Fracture
Colle’s fracture: Distal radial fracture with dorsal angulation
67
Proximal third ulnar fracture with dislocation of the radial head?
Monteggia fracture
68
Middle distal third radial fracture with the dislocation of the radioulnar joint?
Galeazzi fracture
69
Vertebra and its parts affected in Hangman’s fracture?
C2 pedicles
70
Type of fracture where the bone is broken into three or more fragments?
Comminuted fracture
71
Incomplete fracture in which the angulating force bends the cortex on the compression side and breaks it on the distraction site?
Greenstick fracture
72
General principles of radiographic examination of fractures and dislocations ?
1. Two views at right angles
2. Includes joints above and below area of injury
73
Restoration of normal alignment of bone via external manipulation of the fracture or dislocation?
Closed reduction
74
Use of superficial incision to directly visualize and manipulate fracture / dislocation?
Open reduction
75
Gustilo-Andersen open fracture classification of a fracture <1cm long with clean wound and evidence of vascular injury requiring repair. What grade?
IIIC
Presence of vascular injury elevates the fracture to Grade IIIC
76
Antibiotics used to grade II open fractures?
1st gen Cephalosporins + Aminoglycosides
77
Most common site of pressure injury ?
Ischial tuberosity 28%
Greater trochanter 18%
Sacrum 17%
Heel 9%
78
Causes of Type II necrotizing soft tissue infections?
a-hemolytic streptococcus or staphylococcus
79
Pro inflammatory mediators of shock? (7)
IL 1a/B
IL 2
IL 6
IL 8
Interferon
TNF
PAF
80
Anti-inflammatory mediators of Shock ? (5)
IL 4
IL 10
IL 13
Prostaglandin E2
TGFB
