Trauma Review Flashcards
(156 cards)
1
Q
8 causes of spont. pneumo
A
Idiopathic (slender, tall), COPD, infection, neoplasms, sarcoid, marfans, endometriosis, crack smoking
2
Q
How do you treat a pneumatocele
A
Not necessary
3
Q
What does a lung contusion look like
A
Ill defined, patchy alveolar
4
Q
Hypoxia, petechial rash, trauma, AMS
A
fat embolism possible
5
Q
What does fat embolism look like on cxr
A
ARDS
6
Q
If you fracture upper 3 ribs?
A
Think aortic injury
7
Q
If you fracter lower 3 ribs?
A
think liver or splenic
8
Q
What is the threshold for mediastinal widening?
A
8cm
9
Q
What are five findings of aortic injury on CXR
A
Widening of mediastinum, downward displacement of LMSB, tracheal or esophageal displacement, apical capping, left pleural effusion
10
Q
What is apical capping?
A
Density in the apices
11
Q
What percentage of aortic rupture patients have normal cxrs initially?
A
seven %
12
Q
What are signs of inhalation injury?
A
Subglottic edema, diffuse peribronchial infiltration, pulmonary edema, atelectasis.
13
Q
What are later signs of inhalation injury?
A
pneumonia, ARDS, barotrauma, atelectasis, fluid overload
14
Q
What would you see with obstructive aspiration?
A
hyperinflation of distal segment
15
Q
What does radiation therapy look like on CXR?
A
profoundly geometric
16
Q
When do you expect cardiac injury?
A
Blunt to chest with sternal fracture, or severe soft tissue injury
17
Q
What are four manifestations?
A
Contusions (may have trops), rupture of chordae may lead to pulmonary edema, tricuspid injury, aortic dissesction and pericardial effusion
18
Q
What are signs of vascular trauma
A
Hemorrhage, dissection, pseudoaneurysm, arterial spasm, thrombosis, AV fistula
19
Q
Gold standard for PE?
A
Angio. BUT CTA is basically the best option since its not as invasive. Can use MRA
20
Q
When would you use Angio?
A
When CTA is not diagnosis but there is concern, when there is an UNSTABLE person who might need intervention.
21
Q
What are the five most common causes of thoracif aortic aneurysm
A
Athero, trauma, infection, cystic medial necrosis (connective tissue DO, HTN, syphylis), aortitis (colagen vascular dz, takayasu, GCA)
22
Q
When does a thoracic AA need repair?
A
6cm
23
Q
Where are most abdominal aneurysm found?
A
Abdominal
24
Q
What does a mycotic aneurysm look like?
A
perianeurysmal inflammation!
25
What is the most common location for mycotic aneurysm?
ascending aorta and isthmus
26
What are the most common organisms?
Staph A, strep, salmonella, neisseria, mycobacteria tuberculosis
27
What are risk factors for aneurysms?
Ascending see above, descending see above but smoking!
28
What layer is torn in a dissection?
TUNICA
29
What are common causes of dissection?
HTN, marfans, athero, bicuspid aortic valve, coarct
30
What are the two classes of dissection?
Debakey, Stanford
31
Describe the two
Debakey: B A D, I: ascending/descending, II: ascending, III: descending. Stanford: A: ascending proxima to takeoff of left subclavian, B: descending
32
What is the treatment for types A or B?
A surgery, B medical
33
Complications of aortic dissection
Rupture, MI, tamponade, valvular insufficiency, Stroke, mesenteric ischemia, renal insufficiency, paraplegia
34
What causes most aortic injury?
Sudden decelleration
35
What are the three sites most often involved?
Injury at the Aortic Root, the Aortic isthmus, the hiatus of the diaphragm
36
What are plain film signs of aortic injury
Abnormally contoured arch and loss of knob, wide mediastinum, capping, left mediastinal stripe, widened paratracheal area, effusion, broken upper ribs, tracheal deviation
37
is it more likely to see root or isthmus injuries?
Isthmus 95% of time because root injuries die
38
Diagnostic imaging of choice for aortic injury?
CTA
39
When would you use Aortography?
rarely, only if CTA is equivocal or INTERVENTION is planned
40
What does aortic injury look like?
Pseudoaneurysm, intimal tear or defect, irregular contour, extravasation
41
What size is a AAA? What size requires intervention?
3cm. >5cm requires intervention
42
What are four signs of pneumoperitoneum?
Free air under the diaphram, Falciform outline (football sign), Rigler's sign, air between the liver and abdomen on LLD
43
Five causes of pneumoperitoneum
ruptured viscus, surgery, pneumatosis intestinalis, steroid therapy (?), air forced through fallopian tubes
44
How long does post surgical free air last?
4-5 days
45
Causes of pneumatosis
Necrosis, emphysematous gastritis, ulcers, immunocompromise, pulmonary disease, overdistention
46
How to tell portal gas from bile duct gas?
Peripheral portal, central for bile. Think about where the FLOW is
47
Causes of pneumobilia?
ERCP, surgery, fistula, malignancy, gallstone illeus
48
Four radiographic signs of bowel obstruction
transition point, large dilation and fluid in proximal bowel, stair step sign (greater than 3 air fluid levels), string of pearls sign
49
Approach to patient with suspected BO
Plain films, CT can help with SBO. barium enema is good for LBO too
50
Why is the cecum most prone to rupture in distention?
Laplace's law
51
What are the two categories of renal trauma?
Minor injuries (85%, nonsurgical hematomas, contusions, lacerations). Major: pedicular injuries, shattered kidney
52
What are the indications for angiography for trauma patients?
No visualization of kiney on IVP.
53
What are two types of bladder rupture?
Intraperitoneal, extraperitoneal
54
What causes extraperiotoneal rupture?
Pelvic fracture
55
What causes intraperitoneal rupture?
blunt trauma
56
What is a pear-shaped bladder indicative of?
Could be pelvic lipomatosis, IVC occlusion, lymphocele, pelvic lymphadenopathy, healthy patient with iliac muscle hypertrophy
57
What are the types of urethral injury?
I: periurethral hematoma with narrowing. II: rupture above orogenical diaphram. III: Rupture at the urogenital diaphram with superior displacement of the bladder
58
What is the initial treatment for urethral injury?
suprapubic
59
What is a straddle injury?
injury to soft tissue of bulbous urethra
60
What are the risks of urethral injury?
Stricture and impotence
61
What are the four signs of abuse?
Healing fractures of differing ages, multiple fractures, unusual fractures, metaphhyseal fractures
62
What fracture is pathognomonic for abuse?
bucket handle
63
When does periosteal new bone formation take place?
7-10 days
64
When does obliteration of the fracture line show?
14-21 days
65
When does hard callus formation show?
14-28 days
66
When does remodeling of bone happen?
12 months
67
What are five common types of fracture?
Elastic deformation, bowing deformation, torus fracture, greenstick fracture, Salter-Harris fracture
68
What is the difference between elastic adn bowing deformations
Elastic will return to original, whereas bowing deformities stay
69
What is a buckle fracture
bowing of one cortex
70
what is a greenstick fracture?
incomplete fracture in one cortex and periosteal rupture on the opposite side, with intact periosteum on the cortically disrupted side
71
What is a salter harris fracture
Fractures involving the epiphyseal plate
72
What are the types?
I: fracture through the physeal plate. II: fracture through the metaphysis and physis. III: Fracture of epiphysis and physis. IV: fracture through all three structures. V: crushed physis
73
SALTR
Separated, above, lower, through, ruined
74
Where are the uncovertebral joints?
Luschka: They are cervical vertebral body-vertebral body joints
75
What are facet joints
Facet joints are zygapophyseal joints created from the superior and inferior articular processes of the thoracic and lumbar
76
At which levels do you have oncovertebral or facet joints
Cervical uncovertebral, thoracic is facet joints
77
What are the three columns of the spine
Anterior, middle, posterior. Anterior is anterior part of vertebral body and anterior long ligament, middle is the posterior vertebral body and posterior long ligament, and posterior column is the flavum, interspinous, and all things posterior
78
Conus at what level
T12
79
What three bones are the shoulder girdle
scapula, clavicle, humerus
80
What are the parts of the scapula?
acromion, coracoid, body, spine, glenoid fossa
81
What are the muscles of the rotator cuff?
SITS: spuraspinatis, infraspinatus, teres minor, subscapularis
82
Where is the subacromial bursa?
Deep to deltoid, superior to rotator cuff
83
What muscle tendon (not rotator cuff) passes through the shoulder joint capsule?
Biceps long head
84
How does the ulna and humerus articulate?
olecrenon process of ulna articulates with the trochlea and olecranon fossa of humerus
85
How does the radius and humerus articulate?
Capitellum
86
Bones of the wrist mnemonic?
So Long To Pinky, Here Comes The Thumb
87
What are the four joints of the wrist?
Distal radiolunar, Radiocarpal, midcarpal, carpometacarpal
88
What is the scapholunate angle?
measure from the axis that divides the concavity of the scaphoid, to the angle of the lunate, should be 30-60
89
How does the scaphoid receive it's blood?
distal to proximal
90
What is ulnar variance? Normal, Neg/Pos?
Positive ulnar variance is when the ulna is longer than the radius. Normally the articular surfaces should be aligned.
91
What four structures (nine items) are in the carpal tunel
Median nerve, superficial flexor, deep flexors, and flexor pollicis longus
92
What are the parts of the metacarpal?
Base, shaft, neck, head
93
Joints of the fingers?
Carpometacarpal, metacarpophalangeal, interphalageal, distal interphalageal
94
What are the columns of the pelvis?
Anterior and posterior
95
What is the posterior column?
From the sciatic notch to the ischial tuberosity
96
What is the anterior column?
From the anterior superior iliac spine to the pubic symphysis
97
Why are the columns important?
They determine sugical approach
98
What is Shentons line?
Line from medial border of the femoral metaphysis and superior border of the obturator foramen -- should be undisrupted and smooth!
99
Identify important lines of the hip
Ileopectineal, ilioischial, anterior and posterior rim of acetabulum, shentons, acetabular roof
100
How does the femoral head receive blood supply?
Mostly from retrograde arterial supply from the circumflex
101
What are three articulations of the knee?
Medial tibiofemoral, lateral tibiofemoral, and patellofemoral
102
What ar ethe stabilty forming ligaments of the knee?
ACL,PCL, MCL, LCL
103
What are the bones of the hindfoot?
Talus, calcaneus
104
What are the bones of the midfoot?
Navicular, cuboid, and three cuneiform bones
105
What are the bones of the forefoot?
metatarsals, and phalanges
106
WHAT ARE FIVE QUESTIONS you need to answer when looking at plain film?
Alignment, Soft tissue, joint spaces, bone density (sclerosis), cortex
107
What is a stress fracture?
Either a fatigue or insufficiency. Both are types
108
What are sites of fatigue fracture?
tibial shafts, metatarsals, distal fibula, femur, calcaneus, pars, navicular, pubic ramus
109
What are predisposing conditions to insufficiency?
osteoporosis, osteomalacia, fibrous displasia, pagets, hyperparathyroidism, steroids
110
What is the appearance of a stress fracture?
7-14 days after. sclerotic change, periostitis, cortical fracture
111
What is the mnemonic for causes of osteonecrosis?
ASEPTIC
112
What is ASEPTIC
alcohol, sickle, exogenous steroid, pancreatitis, trauma, idopathic, caisson disease (bends)
113
What is OCD?
Osteochondritis Dessicans
114
Where do you typically see OCD?
femoral condyles
115
What are the radiographic features?
Joint effusion, radiolucent separation of the osteochondral fragment from the condyle. said to be from chronic trauma
116
What is arthrodesis?
Fusion by removal of articular cartilage
117
Dislocation vs subluxation?
Sublixation is subtotal loss of congruity.
118
What is pathologic fracture?
Fracture associated around a nidus of disease such as tumor or infection
119
What is occult fracture?
Not visible on plain film?
120
What views should you get of a possible fracture site?
Two views taken at 90 degrees of each other, and also views of the joints above and below
121
What films are required for trauma>
Lateral cervical, Chest, AP pelvic
122
What four peices of info are required for adequate description of a fracture?
ANATOMIC SITE, FRACTURE PATTERN, ALIGNMENT, ASSOCIATED SOFT TISSUE INJURIES
123
Anatomic Site
Bones injured, location, intra/extra articular involvement
124
Fracture Patterns
Simple transverse, comminuted, oblique, spiral, longitudinal, impacted, depressed, avulsion
125
Fracture alignment
Displacement, angulation, rotation, discrepany
126
How is displacement described?
Location of the distal fragment
127
Valgus?
Lateral distal movement, knock-knee
128
Varus?
Medial distal movement, so this would be bowed legs
129
What is pseduoarthrosis
Fracture nonunion leading to joint like creation with a synnovial like cavity.
130
What is malunion, vs nonunion, reactive nonunion, vs infective nonunion?
Different types of nonunion. Malunion is union but not in anatomic alignment
131
Myositis ossificans
Post trauma bone formation in a chronic hematoma in a muscle with a corticated and central lucency
132
What types of things would you see in facial fractures?
Cortical disruption, fragment displacement, asymmetry, air fluid in sinuses, orbital emphysema, STS
133
What view would you get for a nasal fracture?
Water's view
134
What is the most common zygomatic (tripod) arch fracture?
FIZL: frontozygomatic suture, infraorbital rim, zygomatic arch, lateral maxillary wall
135
What is a Lefort fracture?
Fractures that always involve the pterygoid plates and vary in terms of their location through the CC facial structures.
136
What are the most common levels of spinal fracture?
C1-C2, C5-C6, T10-T12
137
Does spinal cord injury happen at the time of injury or later?
MOST will happen at the time of injury!
138
What does flexion extension images show?
ligamentous injury or instability
139
What is the pitfall of flexion extension films in acute setting?
Paraspinous musclulature can spasm, and give you a false negative. hense C collars for 1-2 weeks
140
What is a jefferson's fracture?
Axial loading, splitting of C1 posterior elements
141
Describe dense fractures
Can be different types, some are stable some are unstable
142
What is a Hangman's?
hyperextension. C2 pars fracture.
143
What is a teardrops?
Severe flexion, tear drop is the anterior vetebral body fragment. very unstable, SAD tear outcome
144
What conditions are associated with C1-C2 subluxation
RA, JRA, psoriasis, AS, SLE, Downs, trauma
145
What is a chance injury?
Horizontal fracture
146
Anterior and posterior shoulder dislocation
Anterior is inferior, posterior you sometimes cant see on AP
147
What are Bankart and Hill-Sachs
Bankart is injury to inferior glenoid, and hill-sachs is a depression in the humeral head. Both associated with anterior dislocation
148
What is the posterior fat pad and sail sign?
Indicative of fractures of the elbow, hemarthrosis
149
What is a Monteggia's fracture?
Fracture of the ulna with radial head dislocation
150
What is a Galeazzi's fracture?
Fracture of the proximal radius with distal radioulnar dislocation
151
What is a nightstick fracture?
Ulnar fracture distal diaphysis
152
What is a Colles fracture?
Distal radial fracture falling on outstreatced extended pronated wrist.
153
How would you asses for scaphoid fracture on physical exam?
anatomic snuffbox tenderness
154
What makes a pelvic fracture unstable?
Ring disruption
155
What are four common locations for pelvic avulsions
ASIS: sartorius avulsion, AIIS: rectus femoris, Ischia tuberosity: hamstring avulsion, Lesser trochanter: iliopsoas
156
What's the most common hip dislocation? why?
Posterior, knee to dashboard
