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AGH Emergency Medicine > Head > Flashcards

Head Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

skull “base” comprises of:

A 
frontal
occiput
occipital condyles
clivus
carotid canals
petrous portion of temporal bones
posterior sphenoid wall
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2
Q

basically a linear fracture of the skull base

A

basilar skull fracture

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3
Q

Trauma resulting in fractures to this area typically does not have localizing symptoms.

A

basilar skull fracture

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4
Q

basilar skull fracture

Indirect signs of the injury

A

Battle sign or “raccoon eyes.”
Hemotympanum
blood in the sphenoid sinus
Clear or pink rhinorrhea - dextrose stick test (+), filter paper (halo or double ring)

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5
Q

visible evidence of bleeding from the basilar fracture into surrounding soft tissue

A

Battle sign or “raccoon eyes.”

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6
Q

Bleeding into other structures from basilar fracture—includes

A

hemotympanum

blood in the sphenoid sinus

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7
Q

seen as an air-fluid level on computed tomography (CT)

A

hemotympanum

blood in the sphenoid sinus

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8
Q

clear or pink rhinorrhea

can indicate

A

Cerebrospinal fluid (CSF) leaks

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9
Q

how to confirm that
clear or pink rhinorrhea
is associated with CSF leaks

A

dextrose stick test (+)

filter paper - halo or double ring

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10
Q

Identify underlying brain injury, which is best accomplished by

A

CT

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11
Q

also the best diagnostic tool for identifying the fracture site, but fractures may not always be evident.

A

CT

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12
Q

Evidence of open communication, such as a CSF leak, mandates

A

neurosurgical consultation and admission

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13
Q

are antibiotics recommended in CSF leak

A

controversial because of the possibility of selecting resistant organisms.

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14
Q

Clinical manifestations of basilar skull fracture may take_______ to fully develop.

A

several hours

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15
Q

indications for head CT

and threshold

A

low threshold for head CT in any patient with head trauma, loss of consciousness, change in mental status, severe headache, visual changes, or nausea or vomiting.

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16
Q

The use of filter paper or a dextrose stick test to determine if CSF is present in rhinorrhea is______% reliable.

A

not 100% reliable

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17
Q

Acute periorbital ecchymosis seen in this patient with a basilar skull fracture. These findings may also be caused by facial fractures

A

Raccoon Eyes

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18
Q

Subtle periorbital ecchymosis manifests 1 hour after a blast injury

A

early raccoon eyes

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19
Q

Seen in a basilar skull fracture when the fracture line communicates with the auditory canal, resulting in bleeding into the middle ear

A

hemotympanum

Blood can be seen behind the tympanic membrane

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20
Q

Depressed skull fractures typically occur when

A

a large force is applied over a small area.

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21
Q

when are Depressed skull fractures classified as open

A

skin above them is lacerated

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22
Q

sx that may also be present over the fracture site

Depressed skull fractures

A

Abrasions, contusions, and hematomas
mental status changes - dependent upon the degree of underlying brain injury
evidence of basilar fracture, facial fractures, or cervical spinal injuries

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23
Q

how to manage depressed skull fractures

A
  1. Explore all scalp lacerations to exclude a depressed fracture
  2. CT - determine the extent of underlying brain injury
  3. immediate neurosurgical consultation
  4. Open fractures -antibiotics and tetanus prophylaxis as indicated
  5. decision to observe or operate - made by neurosurgeon
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24
Q

Children below 2 years of age with skull fractures can develop

A

leptomeningeal cysts, which are extrusion of CSF or brain through dural defects

-> children below age 2 with skull fractures require close follow-up or admission

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25
Q

Examine all scalp injuries including lacerations for evidence of fractures or depression. When fragments are depressed _____ mm below the inner table, penetration of the dura and injury to the cortex are more likely.

A

5 mm

26
Q

Children with depressed skull fractures are more likely to develop

A

epilepsy

27
Q

Ping pong ball skull fractures can occur from a

A

forceps delivery or from compression by mother’s sacral promontory during delivery.

28
Q

Patients with head injuries must be evaluated for

A

cervical spine injuries.

29
Q

Akin to the greenstick fracture, occurs when a newborn or infant’s relatively soft skull is indented by the corner of a table or similar object without causing a frank break in the bone

A

Ping pong ball skull fractures

30
Q

Scalp lacerations should undergo

A

sterile exploration for skull fracture

31
Q

Clinically significant nasal fractures are almost always evident with

A

deformity, swelling, and ecchymosis

32
Q

Epistaxis in nasal fractures may be due to

A

septal or turbinate laceration but can also be seen with fractures of adjacent bones, including the cribriform plate

33
Q

is a rare but important complication that, if untreated, may result in necrosis of the septal cartilage

A

Septal hematoma

34
Q

Septal hematoma may lead to this deformity

A

saddle-nose” deformity.

35
Q

has nasal or frontal crepitus and may have telecanthus or obstruction of the nasolacrimal duct.

A

frontonasoethmoid fracture

36
Q

Management nasal fractures

A
  1. Look for more serious injuries first.
  2. CT to rule out facial fractures.
  3. Refer obvious deformities within 2 to 5 days for reduction, after the swelling has subsided
  4. Simple nasal fracture - vigorously irrigate + suture lacerations + antibiotic coverage
37
Q

Nasal fractures with mild angulation and without displacement may be reduced in the

A

emergency department (ED)

38
Q

Nasal injuries without deformity

A

need only conservative therapy with an analgesic and possibly a nasal decongestant

39
Q

septal hematomas on nasal fractures

A

Immediately drain

with packing placed to prevent reaccumulation

40
Q

Uncontrolled epistaxis on nasal fractures

intervention

A

require nasal packing

41
Q

for nasal fractures

to perform a good intranasal examination

A

control epistaxis

42
Q

If obvious deformity is present, including a new septal deviation or deformity, treat with

A

ice and analgesics and provide ENT referral in 2 to 5 days for reduction.

43
Q

patients discharged with nasal packing should be placed on

A

antistaphylococcal antibiotics and referred to ENT in 2 to 3 days

Although the effectiveness of prophylactic antibiotics to prevent toxic shock syndrome is unproven

44
Q

Consider cribriform plate fractures in patients after nasal injury if they present with

A

clear rhinorrhea

45
Q

Patients with facial trauma should be examined for a

A

septal hematoma

46
Q

bluish, grapelike mass on the nasal septum

A

septal hematoma

47
Q

septal hematoma

tx

A

incision, drainage, and packing

48
Q

The zygoma bone has two major components

A

zygomatic arch and the body.

49
Q

forms the inferior and lateral orbit

A

arch

50
Q

forms the malar eminence of the face

A

body

51
Q

Direct blows to the arch can result in

A

isolated arch fractures

52
Q

isolated arch fractures

manifestations

A

pain on opening the mouth

secondary to the insertion of the temporalis muscle at the arch or

impingement on the coronoid process

53
Q

More extensive trauma to the zygomatic arch can result in the

A

tripod fracture

54
Q

tripod fracture

A

consists of fractures through three structures: the frontozygomatic suture;
the maxillary process of the zygoma including the inferior orbital floor, inferior orbital rim, and lateral wall of the maxillary sinus; and
the zygomatic arch

55
Q

tripod fracture

present with

A

flattened malar eminence and edema and ecchymosis to the area, with a palpable step-off on examination

infraorbital paresthesia
gaze disturbances
Subcutaneous emphysema

56
Q

What other structures that can be affected by zygomatic fracture

A

Injury to the infraorbital nerve may result in infraorbital paresthesia

disturbances may result from injury to orbital contents

57
Q

imaging that best identifies zygoma fractures

A

Maxillofacial CT

58
Q

Treat simple zygomatic arch or tripod fractures without eye injury with

A

ice and analgesics and refer for delayed operative consideration in 5 to 7 days.

59
Q

when should you urgently refer zygoma fractured

A

extensive tripod fractures or those with eye injuries

60
Q

intervention

A

refer urgently

Decongestants and broad-spectrum antibiotics - since the fracture crosses into the maxillary sinus

61
Q

Zygoma Fractures with blood in the sinus should also be treated with

A

antibiotics

AGH Emergency Medicine (5 decks)

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