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Flashcards in Trauma Review Deck (156)
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1

8 causes of spont. pneumo

Idiopathic (slender, tall), COPD, infection, neoplasms, sarcoid, marfans, endometriosis, crack smoking

2

How do you treat a pneumatocele

Not necessary

3

What does a lung contusion look like

Ill defined, patchy alveolar

4

Hypoxia, petechial rash, trauma, AMS

fat embolism possible

5

What does fat embolism look like on cxr

ARDS

6

If you fracture upper 3 ribs?

Think aortic injury

7

If you fracter lower 3 ribs?

think liver or splenic

8

What is the threshold for mediastinal widening?

8cm

9

What are five findings of aortic injury on CXR

Widening of mediastinum, downward displacement of LMSB, tracheal or esophageal displacement, apical capping, left pleural effusion

10

What is apical capping?

Density in the apices

11

What percentage of aortic rupture patients have normal cxrs initially?

seven %

12

What are signs of inhalation injury?

Subglottic edema, diffuse peribronchial infiltration, pulmonary edema, atelectasis.

13

What are later signs of inhalation injury?

pneumonia, ARDS, barotrauma, atelectasis, fluid overload

14

What would you see with obstructive aspiration?

hyperinflation of distal segment

15

What does radiation therapy look like on CXR?

profoundly geometric

16

When do you expect cardiac injury?

Blunt to chest with sternal fracture, or severe soft tissue injury

17

What are four manifestations?

Contusions (may have trops), rupture of chordae may lead to pulmonary edema, tricuspid injury, aortic dissesction and pericardial effusion

18

What are signs of vascular trauma

Hemorrhage, dissection, pseudoaneurysm, arterial spasm, thrombosis, AV fistula

19

Gold standard for PE?

Angio. BUT CTA is basically the best option since its not as invasive. Can use MRA

20

When would you use Angio?

When CTA is not diagnosis but there is concern, when there is an UNSTABLE person who might need intervention.

21

What are the five most common causes of thoracif aortic aneurysm

Athero, trauma, infection, cystic medial necrosis (connective tissue DO, HTN, syphylis), aortitis (colagen vascular dz, takayasu, GCA)

22

When does a thoracic AA need repair?

6cm

23

Where are most abdominal aneurysm found?

Abdominal

24

What does a mycotic aneurysm look like?

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