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OS 600 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Pt presents with swelling, a hematoma, and a chin laceration. Which fractures will be included in your DD?

A

symphysis and subcondylar

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2
Q

Pt presents with an anterior open bite after a traumatic accident. He says that his bite was normal before. What would you initially include in your DD?

A

bilateral subcondylar or bilateral md angle fractures

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3
Q

Pt presents with sublingual ecchymoses following an accident. What is this symptom pathognomonic for?

A

Gingival laceration

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4
Q

Which radiograph is considered the gold standard for fractures?

A

CT

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5
Q

What are the most common areas for fracture on the mandible?

A

29.1% Condyle
24.5% Angle
22% Symphysis

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6
Q

If a patient presents with a pyramidal midface fracture, what type of fracture is it?

A

LeFort II

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7
Q

When the patient has a midface fracture that extends through the lateral aspect of the orbit, what type of fracture is it?

A

LeFort III

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8
Q

If the patient has bruising over their mastoid process (battle sign), where would you expect there to be a fracture?

A

At the base of the skull

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9
Q

What are some symptoms that would indicate a midface fracture? what would you see if the nose was involved?

A

step defect, trismus, malar flattening (this can be seen for mx/ZMC fractures)
if nose involved, look for CSF leak

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10
Q

What is the most common bony fracture?

A

nasal fracture

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11
Q

What is the treatment of choice for a nasal fracture?

A

closed reduction

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12
Q

Pt presents with enophthalmus, ocular entrapment, and flattening of the zygomatic prominence. What type of fracture would you suspect?

A

ZMC fracture

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13
Q

When the orbit is involved in a fracture, what type of eye symptoms may you notice?

A

dystopia, ptosis, entrapment, rounding of medial canthal areas, proptosis, exophthalmus

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14
Q

Is monocular or binocular diplopia worse?

A

monocular - you should send the pt for an ophthamology consult - could be a neuro issue

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15
Q

What is the forced duction test?

A

You grasp the tendon of the inferior rectus m. through the conjunctiva and manipulate the globe through its entire ROM. It is used to determine if there is an impediment to ocular motility

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16
Q

If you notice palatal ecchymoses, what type of fracture would you expect?

A

maxillary fracture

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17
Q

What is the most important step in treating a ZMC fracture?

A

Assessment of the reduction (realignment) of the fracture

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18
Q

What treatment method would work well for a LeFort I?

A

Closed reduction - pt must have a satisfactory complement of dentition

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19
Q

If a pt has multiple fractured segments and/or inadequate dentition, what type of treatment is indicated?

A

Surgical splint

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20
Q

What is a Gilles incision?

A

An incision that allows you to access the Zygomatic arch by going under Temporalis

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21
Q

If a patient has a frontal sinus fracture, what type of symptoms would you expect to see?

A

Supraorbital nerve anesthesia, CSF rhinorrea, Depression over frontal sinus, obliteration, cranialization

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22
Q

When is open reduction indication as a method of treatment for a fracture?

A

open injuries or canthal displacement

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23
Q

When both the anterior and posterior portions are avulsed during a medial canthal fracture, where should they be attached?

A

Posterior and superior behind lacrimal creast

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24
Q

When is a canthopolexy indicated?

A

When the tendon avulsed or if the bone attachment is too small for fixation during a medial canthal repair

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25
Q

What is the gold standard type of bone graft?

A

autologous

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26
Q

When should the inside-out concept of fracture repair be employed?

A

For closure of soft tissue - proceed from the bone or oral cavity towards the skin

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27
Q

How do you check for a LeFort II or III fracture?

A

one hand holds the nose, while the other manipulates the maxilla. If you notice movement at the nasofrontal suture, LeFort II or III are suggested

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28
Q

What is the golden hour?

A

The care a pt receives during their 1st hour after the injury will dictate how the pt will do

29
Q

What do ABCDE stand for and what does it signify?

A 
A - airway maintenance w/ cervical spine protection
B - breathing and ventilation
C - circulation w/ hemorrhage control
D - Disability (neuro eval.) - GCS
E - Exposure and environmental control
30
Q

What are some injuries that may impair ventilation?

A

tension pneumo, flail chest w/ pulmonary contusion, massive hemothorax, open pneumo

31
Q

Why are urinary catheters often inserted when assessing for circulation?

A

Urinary output is a sensitive indicator of the volume status

32
Q

When should the provider move on to the secondary survey?

A

When the primary survey is complete and the patient is demonstrating normalization of vital function - this is when definitive care is done

33
Q

What is a good way of assessing the patient quickly?

A

Ask them their name. If they can answer clearly and accurately, then you will have a lot of info

34
Q

When is patient intubation (definitive airway) indicated?

A

unconscious patient, need for ventilation, impending airway obstruction (this happens for patients w/ burns), apnea, need to protect the lower airway from aspiration, presence of closed head injury (GCS <8

35
Q

What is the difference between oxygenation and ventilation?

A

oxygenation - supply of oxygen to lungs, intake O2

ventilation - elimination of CO2

36
Q

What are two good techniques to maintain a patient’s airway while minimizing the risk of compromising a possible cervical spine injury?

A

Chin lift, or jaw thrust (oropharyngeal (unconscious pt) or nasopharyngeal airways are also helpful)

37
Q

What is shock?

A

A state of hypoperfusion and poor O2 delivery to the tissues

38
Q

How do you treat shock before diagnosing it?

A

By giving the patient 2 large gauge IVs w/ saline and lactated ringers (electrolytes)

39
Q

What is the most common type of shock?

A

Hypovolemic - decreased circulating blood in the body

40
Q

When a patient is experiencing hypotension w/o tachycardia, what type of shock is occuring?

A

Neurogenic shock - the patient is losing sympathetics

41
Q

What are typical symptoms of shock?

A

altered consciousness, cold, tachycardia, tachypnea

42
Q

Where in the body could you be losing blood and not see any symptoms?

A

chest, thigh (femur), pelvis

43
Q

How does pulse pressure react when a pt experiences hemorrhage?

A

Decreases - systolic pressure decreases first and diastolic pressure maintains

44
Q

What is the first stage of hemorrhage where you will notice a decrease in the pt’s BP?

A

Class III (usually pulse pressure decreases too) - 1.5-2 L blood lost - If pt has a good BP, then they have lost <1.5 L blood

45
Q

What is indicated when a pt does not respond to fluid administration?

A

persistent blood loss, unrecognized fluid losses, non-hemorrhagic shock

46
Q

What kind of symptoms would you see in a patient with a tension pneumothorax?

A

Respiratory distress, shock, distended neck veins, unilateral decrease in breath sounds, hyperresonance, cyanosis

47
Q

How is an open pneumothorax initially managed?

A

place a vaseline gauze and secure it on 3 sides over the open wound - chest tube placement is essential as soon as possible

48
Q

What does Beck’s triad indicate the patient has?

A

Cardiac tamponade

49
Q

What is involved in Beck’s triad?

A

decreased arterial pressure, distended neck veins, muffled heart sounds

50
Q

What is pulseless electrical activity and when is it seen?

A
  • Cardiac electrical activity w/o a heartbeat

- seen in cardiac tamponade

51
Q

Why do you have to use judicious fluids when a pt has flail chest?

A

Too much fluids can cause edema in the patient

52
Q

How is flail chest typically treated?

A

with nerve blocks, intubation, analgesia, and fluids

53
Q

When is a hemothorax typically discovered, since it yields no external signs?

A

When shock is associated w/ the absence of breath sounds and/or dullness to percussion on one side of the chest

54
Q

How is a hemothorax initially managed?

A

Restoration of blood volume and decompression of hte chest cavity

55
Q

What is the monroe-kellie doctrine?

A

The pressure within the skull will remain the same in the presence of a mass by releasing venous blood and CSF. If the mass gets too big, then intracranial pressure will increase (you want to remove the hematoma before this point)

56
Q

What does increased Intracranial Pressure (ICP) cause?

A

Cushing’s triad: hypertension, bradycardia, bradypnea

57
Q

Explain an epidural hematoma.

A

Trauma to the temporal/parietal area causing a middle meningeal artery tear. Pt will experience a lucid interval, then it will become rapidly fatal

58
Q

What will be seen on a CT during a subdural hematoma?

A

rim/crescent shape and a midline shift of >5mm (due to shifting of the 4th ventricle

59
Q

What usually causes a subdural hematoma?

A

a tear in cerebral veins

60
Q

What is a coup/contrecoup injury and when does it occur?

A

When the brain hits one side of the skull from the initial traumatic impact, then it hits the other side afterward. It occurs with large frontal contusion

61
Q

What would you expect if you saw a unilateral fixed dilated pupil in a patient?

A

an ipsilateral hematoma

62
Q

What are the GCS ranges for mild, moderate, and severe head injuries?

A

13-15, 9-12, 3-8 respectively

63
Q

Which spinal region is the most vulnerable to injury?

A

Cervical spine injury

64
Q

What is neurogenic shock characterized by?

A

Hypotension and Bradycardia in response to hypovolemia due to vasodilation and pooling of blood in the lower extremities

65
Q

What is central cord syndrome and what is an example of an instance of when it can occur?

A

It is a disproportionately greater loss of motor power in the upper extremities than the lowers. Could occur if you jump down from a high place, land on your feet and your spinal cord gets compressed

66
Q

What is Brown-Sequard’s Syndrome?

A

Ipsilateral motor loss and loss of position sense associated with contralateral loss of pain and temperature due to a hemisection of the spinal cord

67
Q

What is the most common fracture of C1 (Atlas)?

A

Jefferson fracture

68
Q

What vertebrae is involved in a hangman’s fracture? and what causes it?

A

C2 (Axis) - usually cause by an extension type of injury to the neck (such as it snapping back)

OS 600 (3 decks)

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