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Fitz 9th > 98 - Cold Injuries > Flashcards

98 - Cold Injuries Flashcards

1
Q

Y/N: The human capacity for physiologic adaption to cold is minimal

A

Yes

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2
Q

The body can maintain a constant temperature of approximately 37C over a range of external temperatures between

A

15C and 54C

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3
Q

Core body temperature is prioritized and maintained largely by controlling

A

Cutaneous blood flow

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4
Q

Arteriovenous anastomoses are abundant in

A

Acral areas

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5
Q

In prolonged cold exposures, the skin experiences a paradoxical cyclic vasodilation known as _____, to protect against skin necrosis from prolonged vasoconstriction

A

Hunting reaction of Lewis

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6
Q

(Slow/Fast) freezing results in extracellular formation of ice whereas (slow/fast) freezing tends to produce intracellular ice

A

Slow

Fast

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7
Q

In (slow/fast) rewarming, ice crystals become larger and more destructive

A

Slow

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8
Q

Other biologic factors influence vasoconstriction and tissue damage besides temperature

A

Painful stimuli
Mental stress
Arousal stimuli
Deep breaths

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9
Q

Individual factors predisposing to cold injuries include

A 
Skin conditions with TEWL (eg, atopic dermatitis)
Physical injuries
Leanness
Low physical fitness level
Fatigue
Dehydration
Previous cold injuries
Sickness
Trauma
Poor peripheral circulation
Poor clothing insulation
Old age
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10
Q

(Under-/Over-)weight persons are more likely to survive prolonged accidental cold exposure

A

Over-

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11
Q

Y/N: Habitually cold-exposed skin develops a more efficient system for shunting blood away from the surface

A

Yes

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12
Q

Y/N: Individuals who have experienced previous severe cold injury may have a profoundly delayed or absent hunting reaction in the affected limbs, making them more susceptible to recurrent cold injury with pain, hyperesthesia, or paresthesia

A

Yes

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13
Q

Skin cold injuries can be divided into _____ cold injuries

A

Freezing

Nonfreezing

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14
Q

Freezing cold injuries

A

Frostbite
Iatrogenic cold injury
Self-inflicted cold injury

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15
Q

Nonfreezing cold injuries

A 
Vasoconstriction
Hunting reaction
Immersion foot
Pulling-boat hands
Acrocyanosis
Chillblains
Cold urticaria
Cold panniculitis
Erythromelalgia
Raynaud phenomenon
Sclerema neonatorum
Subcutaneous fat necrosis of the newborn
Livido reticularis
Cryoglobulinemia
Cold agglutinins
Cryofibrinogenemia
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16
Q

Occurs when tissue freezes after exposure to cold air, liquids, or metals

A

Frostbite

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17
Q

The clinical presentation of frostbite falls into 3 categories

A

Frostnip (mild frostbite)
Superficial frostbite
Deep frostbite

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18
Q

Frostbite:
Involves only the skin and damage is reversible
Sensation of severe cold progressing to numbness followed by pain
No edema or bleb formation

A

Frostnip

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19
Q

Only form of frostbite that can be treated safely in the field with first aid measures

A

Frostnip

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20
Q

Frostbite:
Involves the skin and immediately subcutaneous tissues
With pain subsiding to feelings of warmth (sign of severe involvement)
Clear blebs form, accompanied by edema and erythema

A

Superficial frostbite

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21
Q

Frostbite:
Extends to the deep subcutaneous tissue
Affected skin becomes deceptively pain free, and the discomfort of feeling cold vanishes
Tissue is totally numb
Large blisters form
Leads to formation of hard, black gangrene

A

Deep frostbite

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22
Q

Good prognostic signs of frostbite

A

Large, clear blebs extending to the tips of the digits
Rapid return of sensation
Rapid return of normal (warm) temperature to the injured area
Rapid capillary filling time after pressure blanching
Pink skin after rewarming

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23
Q

Poor prognostic signs of frostbite

A

Hard, white, cold, insensitive skin
Cold and cyanotic skin without blebs after rewarming
Dark hemorrhagic blebs
Early evidence of mummification
Constitutional signs of tissue necrosis, such as fever and tachycardia
Cyanotic or dark red skin persisting after pressure
Freeze-thaw-refreeze injury

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24
Q

Keystone of treatment of frostbite

A

Rapid rewarming

25
Q

Rewarming should be performed in a water bath between 37C and 39C until

A

The most distal parts of the body are flushed

26
Q

Surgical debridement is often best delayed until _____ after demarcation

A

1 to 3 months

27
Q

Sequelae of frostbite

A 
Permanent hypersensitivity to cold
Hyperhidrosis
SCC
Epiphyseal plate damage or premature fusion
Frostbite arthritis
Ossification of one or both ears
28
Q

Iatrogenic cold injury can be caused by

A

Cryodestruction using liquid nitrogen

29
Q

Chemicals that are capable of cold-induced skin injury include the _____ in propellants, refrigerants, and liquefied petroleum gases

A

Fluorinated hydrocarbons

30
Q

Perioral or perinasal dermatitis with pyoderma

A

“Huffer’s rash”

31
Q

Salt rapidly (decreases/increases) the freezing point of water

A

Decreases

32
Q

Nonfreezing cold injury occurs when tissues are cooled to temperatures between _____ for hours to days

A

0C and 15C

33
Q

Nonfreezing cold injury is historically known as

A

“Trench foot”

34
Q

Dryness of the skin, particularly on the lower extremities, during wintertime

A

Winter xerosis

35
Q

Vasoconstriction can alter both skin temperature and skin color, resulting in a blue to violaceous _____, a bilateral dusky mottled or confluent red to blue discolotation of the hands, feet, nailbeds, and sometimes the face
Persistent and accentuated by cold exposure
Trophic changes and pain do not occur
Pulses are present

A

Acrocyanosis

36
Q

Acrocyanosis must be distinguished from _____, which is clearly episodic, often segmental, and painful

A

Obstructive arterial disease

Raynaud phenomenon

37
Q

Defined by the presence of hand edema superposed on acrocyanosis

A

“Puffy hand syndrome”

38
Q

Tissues are (more/less) sclerotic in acrocyanosis than in Raynaud phenomenon

A

Less

39
Q

In cases of acryocyanosis developing for the first time late in life, an underlying _____ should be exluded

A

Myeloproliferative disorder

40
Q

Localized inflammatory lesions caused by continued exposure to cool temperatures (above freezing)

A

Pernio (chillblains)

41
Q

Y/N: Pernio shows a genetic predisposition

A

Yes

42
Q

Pernio has been described most often in

A

Temperate regions, where winters are commonly cold and damp

43
Q

Pernio is more common in

A

Children
Women
Persons with low body mass index

44
Q

A papular form of pernio resembling _____ can occur at all times of the year, usually in crops on the sides of the fingers, often superimposed on a backgroud of acrocyanosis

A

Erythema multiforme

45
Q

A peculiar clinical presentation of _____ may occur in young women riding horses for several hours daily during winter

A

Pernio

46
Q

Lupus pernio is a variant of _____ and is unrelated to cold injuries

A

Sarcoidosis

47
Q

Pernio demonstrating a chronic course (continuous for at least 4 weeks and, in some cases, 8 weeks or longer, or episodic in nature), persistence into warm weather months, and in onset in the elderly may be suggestive of

A

An associated connective tissue disease, hematologic malignancy, or other systemic condition

48
Q

Erythematous macules and plaques on the dorsum of the hands and fingers of sailors aboard rowboats

A

Pulling-boat hands

49
Q

Rare autosomal dominant condition with onset at an early age and persistence throughout life
Urticaria develops when the patient is exposed to generalized cooling

A

Familial cold urticaria

50
Q

A mutation in the _____ gene, which is responsible for cold-induced autoinflammatory syndrome, has been identified in familial cold urticaria

A

CIAS1

51
Q

Cold urticaria may be a sign of _____ that associates urticaria, deafness, and amyloidosis

A

Muckle-Wells syndrome

52
Q

Cold urticaria may be a sign of _____ that associates urticaria, deafness, and amyloidosis

A

Muckle-Wells syndrome

53
Q

Relies on using 2 different sufficiently cold, microprocessor-controlled heat-transferring metals to generate a precise skin surface temperature to induce lesions

A

Peltier effect-based temperature challenge

54
Q

First-line treatment for cold urticaria

A

Second-generation H1 antihistamines, up to 4 times the standard dose

55
Q

Related disorder to cold urticaria with erythema and pain but without urticaria

A

Cold erythema

56
Q

Rare autosomal dominant disease characterized by childhood onset of nonpruritic, erythematous patches often accompanied by influenza-like symptoms and leukocytosis after generalized exposure to cold
Results of the ice cube tests are negative

A

Familial polymorphous cold eruption

57
Q

Nonfreezing injury leading to inflammatory reactions in the subcutaneous fat layers
More common in children
Most commonly affects the cheeks and legs
Eating popsicles is a common trigger

A

Cold panniculitis

58
Q

_____ have a higher content of saturated fatty acids in adipose tissue, and this may result in solidification at less-cold temperatures

A

Infants

Fitz 9th (108 decks)

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