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PGY1 > MSK > Flashcards

MSK Flashcards

1
Q

definition lisfranc injury

A

spectrum of injury from sprain to complete disruption of tarso-metatarsal joints in midfoot, usually occuring at base of 2nd metatarsal

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2
Q

mechanism of injury associated with lisfranc injury

A

foot being caught in a hole; falling off horse with foot caught in stirrup; MVC, foot planted in hole, awkward step off curb; bunk bed fracture (leaps onto bunk bed, landing on toes with axial load on plantar flexed ankle

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3
Q

MOA of lisfranc injury

A

plantar flexion with ER of ankle

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4
Q

Physical Exam findings for lisfranc fracture dislocations

A

unable to weight bear, hemtama/ecchymosis on plantar aspect of foot

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5
Q

X-Ray orders for LisFranc fracture

A

3 views - AP, later, standard 45 degrees oblique of foot

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6
Q

XRay findings for Lisfranc injury

A

widening between bases of 1st and 2nd or 2nd and 3rd metatarsal bases; > 2mm = surgical intervention

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7
Q

Normal alignment of metatarsals and tarsal bones in midfoot

A

AP view: edge of base 2nd metatarsal lining up with medial edge of medial cuniform; oblique: medial edge of 3rd and 4th metatarsal should line up with medial edges of middle and lateral cuniforms

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8
Q

Pathognomonic for lisfranc injury on XRay

A

fleck sign: small bony fragment avulsed from second metatarsal base or medial cuniform

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9
Q

Indications for surgery for lisfranc

A

displaced fracture or subluxation > 2 mm

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10
Q

If highly suspicious for lisfranc despite normal Xrays…

A
  1. 30 degrees oblique XRay (eliminate overlap of metatarsals), 2. weight-baring stress views following nerve block, 3. CT of foot
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11
Q

ED MGMT of LisFranc injury

A

posterior back slab

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12
Q

carpal bones (5) list them

A

scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, trapezium

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13
Q

(3) Physical tests to r/o scaphoid injury

A
  1. palpate scaphoid on palmer aspect with wrist radially deviated; 2. thumb axial load tenderness at scaphoid location 3. snuffbox tenderness
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14
Q

what is the watson test?

A

identifies scapholunate ligament injury or scaphoid fracture; start with palmer aspect on scaphoid wrist deivated ulnar and flexed, then move wrist radially with slight extension; (+) if pain, apprehension or clunk/subluxation

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15
Q

MOI for perilunate injuries

A

FOOSH

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16
Q

definition of perilunate dissociation

A

capitate dislocated from lunate

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17
Q

definition of lunate dissociation

A

lunate dislocated from capitate (more proximal one)

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18
Q

definition of scapholunate dissociation

A

terry thomas/madonna sign: visible gaps between teeth; gap of > 3 mm between scaphoid and lunate

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19
Q

FOOSH + acute carpal tunnel syndrome =

A

perilunate dissociation until proven otherwise

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20
Q

Xray finding for lunate dissociation

A

spilled tea cup - lunate is out of the seat of the capitate

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21
Q

ED MGMT of perilunate dislocation

A

90 degrees flexed at elbow with finger traps placed 10 - 15 lbs of longitudinal traction for 10 mins, if dorsally displaced, extend wrist and apply traction, then flex with volar/palmer pressure applied to lunate until clunk heard; volar/palmer slab!

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22
Q

DRUJ

A

distal radial ulnar joint injury

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23
Q

MOI of DRUJ

A

FOOSH injury +/- distal radial fracture

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24
Q

Physical findings for DRUJ

A

more prominent ulnar styloid, crepitus or blocking with pronation or supination, piano key sign, ulnar fovea sign

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25
Q

definition of piano key sign

A

ability to ballot the ulnar styloid (push ulna up and down like piano); + if painful or ulnar laxity

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26
Q

definition of ulnar fovea sign

A

point tenderness over ulnar capsule palmar to extensor carpi ulnaris tendon

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27
Q

XRay findings of DRUJ

A

can have normal XRay; widening of ulnar/radial joint of > 2 mm, lateral view: displacement or subluxation of distal ulnar compared to radius

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28
Q

ED MGMT DRUJ

A

reduction (supination and pressure over ulnar head), above elbow splint similar to smith fracture with forearm supinated and wrist in slight extension

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29
Q

pelvic apophyseal avulsion fracture sites

A

most common: ischial tuberosity, other sites: iliac crest, ASIS, AIIS, greater trochanter, lesser trochanter

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30
Q

MOI of pelvic apophyseal avulsion fractures

A

sudden forceful concentric or eccentric muscle contraction during running, jumping, kicking

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31
Q

RFs for pelvic apophyseal avulsion fractures

A

young athletes, hip pain or buttock/groin pain

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32
Q

MGMT for pelvic apophyseal avulsion fracture

A

non weight bearing using crutches then weaned; longer healing than sprains

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33
Q

Definition of Trivial Head Injury (pediatric)

A

GCS 15, no LOC, low mechanism, small frontal hematoma, older than 1 yo

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34
Q

Definition of Minor Head Injury (pediatric)

A

GCS 14 - 15, LOC/amnesia/confusion, disorientation, vomiting/HA, impact seizure

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35
Q

Definition of Moderate-Severe Head Injury (pediatric)

A

GCS < 13 or deteriorating GCS, penetrating head injury, focal neurological findings, late seizures (not impact), known child abuse

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36
Q

Glasgow Coma Scale Definition

A

Eyes (4): closed, responds to pain, responds to voice, spontaneous; Voice (5): no response, sounds, inapproprpiate words, confused, oriented to person/place/time; Motor (6): no response, abnormal extension, abnormal flexion, withdraws from pain, moves to localize pain, obeys commands

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37
Q

RFs for TBI in pediatric patients with head trauma

A

scalp hematoma > 2 cm that is not frontal, skull fracture in < 2 yo

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38
Q

Tool to use for risk of TBI in patients < 2 yo

A

PECARN study

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39
Q

Tool to use for CT head imaging in pediatric patients

A

CATCH Study

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40
Q

Cushing’s Triad

A

hypertension, bradycardia, abnormal breathing

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41
Q

Agent for sedation in raised ICP patients (pediatric)

A

etomidate, ketamine

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42
Q

“Red zone” Period for observation in head injury

A

first 6 hours

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43
Q

“yellow zone” for observation in head injury

A

next 24 hours

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44
Q

T or F; children have less seizures following HI

A

false; they have more seizures

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45
Q

T or F; children are more likely to have TBI following head trauma

A

false; they are less likely to have TBI after head trauma as their skulls are not closed

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46
Q

T or F; children sustain fewer mass lesions and hemorrhagic contusions following a HI

A

true

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47
Q

T or F; children sustain less diffuse brain swelling following a HI

A

false; they have more diffuse swelling and can talk and deteriorate with edema alone

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48
Q

T or F; children sustain less diffuse axonal injury in HI

A

false

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49
Q

T or F; children sustain more hypoxia in HI

A

true

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50
Q

ACL injury MOI

A

rotation of knee against immobile foot with sudden deceleration (i.e., basketball), classic pop heard

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51
Q

Physical Exams for ACL injury

A

pivot shift test, lachman test, anterior drawer (poor sensitivity)

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52
Q

Ottawa Knee rule criteria

A

not weightbearing more than 4 steps, older than 55 yo, pain at fibular head, isolated patellar tenderness, inability ti flex knee to 90 degrees

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53
Q

Fractures associated with ACL injuries

A

Segond fracture, tibial spine fracture

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54
Q

definition of Segond fracture

A

vertical oriented avulsion fracture of the lateral proximal tibia

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55
Q

ED MGMT of ACL injuries

A

removable splint, crutches, ROM exercises, follow-up in sports clinic

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56
Q

Indications to consult ortho for ACL injuries

A

displaced fracture or fracture with impaired extensor mechanism associated with ACL injury

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57
Q

DDx for limping child

A

fracture, septic arthritis, systemic illness; transient synovitis, Legg-Calves-Perthes disease, Slipped capital femoral epiphysis, toddler’s fracture

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58
Q

definition of transient synovitis

A

self-limited inflammation of synovial lining preceeded by viral infection, resolving 3 - 10 days

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59
Q

definition of toddler’s fracture

A

spiral fracture seen in ages 9 - 36 months, usually at distal tibia

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60
Q

Signs with toddler’s fracture

A

pain with ankle dorsiflexion or calf rotation

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61
Q

MGMT of toddler’s fractures

A

above-knee immobilizing splint with knee in slight flexion, outpt follow-up, can consider not splinting if mild symptoms

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62
Q

definition of Legg-Calves Perthes disease

A

avascular necrosis of femoral head; ages 4 - 10 , normal or subtle changes in XRay

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63
Q

Slipped Capital Femoral Epiphyses (SCFE)

A

pain radiating to thigh or knee; Overweight children, pain worst at IR of hip

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64
Q

sign on xray for SCFE

A

Kline’s line is abnormal (line from external part of femoral neck intersecting part of femoral head)

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65
Q

Kocher’s Criteria for Septic Arthritis in Pediatric Pts

A

not weight bearing, ESR > 40, fever, WBC > 12000

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66
Q

Red Flags for non-accidental trauma

A

delay in presentation, vague or inconsistent mechanism, injury inconsistent with developmental stage

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67
Q

Ottawa Ankle Rules age cut off

A

older than 5 yo

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68
Q

SALTER criteria for ankle fractures

A

I: slipped, II: above growth plate, III: lower of the growth plate, IV: through growth plate and metaphysis and physis, V: rammed: growth plate is crushed

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69
Q

Tillaux fracture definition

A

Salter III - intra-articular with avulsion of anteriorlateral tibial epiphysis

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70
Q

Definition of triplanar fracture

A

combination of salter I, II, III requiring operation, seen in adolescents

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71
Q

Definition of buckle fracture

A

incomplete fracture of the long bone identified by bulging of cortex

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72
Q

Definition of Greenstick fracture

A

cortex broken on one side, other side is intact

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73
Q

Acceptabe degrees of angulation for pediatric radial fractures

A

< 5yo: 30 degrees, 5 - 10 yo: 20 degrees, 10 - 12: 10 degrees

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74
Q

Supracondylar fracture major risk

A

neurovascualr injury (brachial artery, median/anterior interosseus nerve), compartment syndrome

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75
Q

figure of eight in elbow Xray

A

confirms lateral position

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76
Q

radiocapitellar line on elbow xray

A

should bisect capitellum of humerus, if not think fracture

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77
Q

anterior humeral line on elbow xray

A

line along anterior border of humerus bisecting middle 1/3 of capitellum; if disrupted, think fracture

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78
Q

“CRITOE” approach to elbow xrays

A

capitellum, radial head, internal epicondyle, trochlea, olecranon, externa epicondyle

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79
Q

ED MGMT of supracondylar fractures

A

immobilize in above-elbow splint at > 90 degrees flexion; consult ortho immediately if displaced

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80
Q

Test for sensory and motor of radius

A

webspace (dorsal) 1st thumb and thumbs up with resistance

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81
Q

Test for sensory and motor for median

A

2nd finger tip, peace sign with resistance

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82
Q

Test for sensory and ulnar

A

5th finger palmer, OK sign

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83
Q

levels of accepted angulation of metacarpal neck fractures

A

5th: 40 degrees, 4th: 30 degreed, 3rd: 20 degrees, 2nd: 10 degrees

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84
Q

definition of fight bite

A

laceration + boxers fracture

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85
Q

ED MGMT of fight bite

A

Xray to r/o fracture and tooth fragments, high flush irrigation, antibiotics (clavulin), healing by secondary intent, close follow-up; admit if extensor tendon injury or few days after injury

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86
Q

indications for abx for lacerations

A

hand bites, bites over joints, immunocompromised

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87
Q

boxer fracture definition

A

4th or 5th MTC neck fracture

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88
Q

MGMT Of boxer fracture

A

Abx, 2ndary intention if open, if angulated > 45 degrees or rotation > 20 degrees refer to hand surgeon/ortho, reduce with splint

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89
Q

Contraindications to tendon repairs

A

flexor tendons, contaminated wounds, partial tendons > 50% torn

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90
Q

ED MGMT of tendon repair

A

can repair if it is partial extensor tendon: thorough washing, loosely close skin, apply splint to avoid tension

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91
Q

(2) flexor tendons in the fingers

A

flexor digitorum profundas (FDP) - DIP, flexor digitorum superficialis (FDS) - PIP

92
Q

Method to examining extensor tendon injury

A

start with palpation for tenderness, then with gradual resistance: gradual resistance test to avoid converting partial tear into complete tear. if normal motor but pain, consider partial laceration

93
Q

gamekeeper thumb definition

A

injury to ulnar aspect (medial) of 1st MCP

94
Q

MOI of gamekeeper thumb injury

A

commonly skier thumb (lateral or valgus stress to abducted thumb)

95
Q

Physical exam for gamekeeper thumb

A

Maximal tenderness on ulnar aspect of 1st MCP, pincer grasp is painful

96
Q

XRay finding for gamekeeper thumb

A

avulsion fracture of proximal phalynx

97
Q

Definition of Stener’s Lesion

A

displaced proximal end of ulnar collateral ligament of 1st MCP being trapped in adductor aponeurosis, thus not allowing healing

98
Q

ED MGMT of Gamekeeper thumb

A

partial injury: 6 week splint; complete tear: surgery, thus requiring thumb spica splint with f/u within 7 days

99
Q

Complications of gamekeeper thumb

A

nonunion, reconstruction

100
Q

Key findings suggesting gamekeeper thumb

A

weak pincer grasp, tenderness at volar ulnar aspect of MSP, >40 degrees deviation in extension or 20 degrees in flexion

101
Q

Risk with high-pressure injuries of hand

A

compartment syndrome: amputation due to ischemia, infections;

102
Q

Sx of compartment syndrome in hand

A

pain out of proportion, hand in claw position ( MCP extended PIP flexed), XRay showing subcutaneous air

103
Q

definition of flexor tenosynovitis

A

inflammation of synovium due to infection or inflammatory

104
Q

Kanavel’s 4 Cardinal Signs for Flexor Tenosynvitis

A

finger held in slight flexion, fusiform swelling, flexor tendon sheath tenderness, pain with passive extension

105
Q

Complications with flexor tenosynovitis

A

scarring, necrosis, disability, infection

106
Q

ED MGMT of flexor tenosynovitis

A

IV antibiotics, immobilize, elevate; can consider I&D if delayed

107
Q

paronychia definition

A

a nail infection where the nail and skin meet at the side or the base of a finger or toenail.

108
Q

mild paronychia MGMT

A

soaking finger, PO antibiotics

109
Q

abscessed paronychia MGMT

A

blunt dissection with point of surgical blade so lateral nail fold is elevated and sulcus between plate and epithelium is entered, drain pus and irrigate cavity with syringe

110
Q

abscessed paronchyia MGMT with finger or pulp involvement

A

can consider additional incision of finger tip pad to drain

111
Q

Back pain ddx to r/o in th ED

A

cauda equina (disc herniation), bone mets, spinal abscess, leaking or ruptured AAA, retroperitoneal bleed, spinal bleed

112
Q

Red flags for back pain

A

age > 50, history of cancer, fever, IVDU, immunocompromised, trauma, cauda equina/SCC symptoms (erectile dysfunction)

113
Q

Suspicious back pain signs in the ED

A

constant back pain that is worse with lying down

114
Q

Dx to r/o with renal colic

A

AAA

115
Q

Dx to r/o with pyelonephritis

A

spinal infection

116
Q

Physical examination for cauda equina or SCC

A

gait, palpation, neurological, abdomen for AAA and bladder distension, DRE

117
Q

PVR cut off for cauda

A

< 100 is negative predictive value for 99%

118
Q

winking owl sign

A

missing pedicle on PA view of spine, concerning for mets spinal fracture (blastic lesions)

119
Q

CT vs MRI for spinal fractures/bony mets

A

CT&raquo_space; MRI for vertebral fracture and mets; MRI&raquo_space; CT for spinal infections, malignancy and cauda equina

120
Q

Indications for urgent MRI in the ED

A

sudden or rapid change in back pain WITH new or pgoressive signs of SCC, suspected mets with stable symptoms (within 24 hours), back pain + Xray finding of mets but no neurological deficits (within 3 -7 days)

121
Q

Bragard sign

A

specific for sciatica: SLR until point of radiating pain, leg then lowered slightly and ankle is dorsiflexed, if pain returns then it is (+) for sciatica (specific)

122
Q

Slump test sign

A

pt sits at edge of bed, slumps forward while flexing neck, knee extended; if +, sciatica

123
Q

Inv to order in spinal epidural abscess

A

ESR, CRP

124
Q

Sx of leaking AAA

A

groin pain, syncope, paralysis, flank fullness, pulsatile, abdo mass, femoral neuropathy; + Psoas sign: retroperitoneal irritation

125
Q

Sx of spontaneous retroperitoneal bleed

A

similar to AAA, low back pain radiating to groin, hip, anterior thigh, RF: anticoagulants

126
Q

5 initial tests in the ED for LBP

A

PVR, ESR/CRP, XRay, POCUS, calcium

127
Q

Talus fracture MOI

A

axial loading with dorsiflexed ankle and everted, seen in snowboarders

128
Q

Sx of talus fracture

A

tender anterior talofibular ligament (like ankle sprains)

129
Q

DDx for talus fracture

A

ankle sprain, distal fibular fracture, clcenus fracture, posterior talar fracture, talar dome fracture, achilles tendon rupture

130
Q

XRay findings in talus fracture

A

normal often; can consider Broden’s View Xray (mortise ankle view with plater foot flexed), or CT

131
Q

MGMT of talus fracture

A

if non displaced or < 2 cm involving lateral talus, immobilization with back slab and non-weight bearing; if > 2 mm displaced ortho!

132
Q

mimics of ankle sprain

A

lateral talus fracture (snowboarder fracture), anterior calcaneus fracture, posterior talar fracture, talar dome fracture, achilles tendon rupture

133
Q

Sx of occult hip fracture

A

groin pain, tenderness in groin, inability to SLR, painful limitation of rotation of hip, pain on axial loading of limb

134
Q

Percussion test for hip fracture

A

stethescope on pubis symphysis and percuss patella on each side; if decreased, consider fracture

135
Q

XRay of the hip: lines to look for

A

Shenton’s Line: arc from medial aspect of femoral neck to obturator foramen

136
Q

occult knee dislocation mechanism

A

MVC- jammed knee

137
Q

key thing to r/o with knee dislocation

A

RULE OUT VASCULAR INJURY = ALWAYS ORDER CT ANGIO

138
Q

(3) key maneuvers for scaphoid fractures

A

palpation of snuffbox, axial loading of thumb with pain in the anatomical snuffbox, palpation of palmar aspect of scahpoid with wrist radially deviated

139
Q

imaging for suspected scpahoid fracture

A

scaphoid views, clenched fist view, CT

140
Q

complications with scaphoid fractures

A

avascular necrosis and fracture nonunion the more proximal

141
Q

ED MGMT of scaphoid fracture

A

colles splint, immobilization, consider ortho referral in the ED if > 1 mm displacement

142
Q

DDx for posterior shoulder dislocation

A

electrocution, epilepsy, EtOH

143
Q

Xray view for posterior dislocation

A

axillary view is key! look for lightbulb sign in AP view

144
Q

ED MGMT of posterior dislocation

A

reduction if < 50% displaced and within 6 weeks of injury; consult ortho if > 6 weeks of injury or greater than 50% of humeral surface is involved

145
Q

MSK injuries associated with fall from height

A

vertebral fractures, calcaneus fracturs, ankle fractures, lisfranc dislocation

146
Q

calcaneal fracture mechanism

A

fall from height

147
Q

physical findings for calcaneal fractures

A

plantar ecchymosis

148
Q

Imaging for suspected calcenal fractures

A

Xray - look for Bohler’s angle, harris view of the ankle (45 degrees), CT if unsure

149
Q

Definition of bohler’s angle

A

posterior tuberosity to the apex of the posterior facet + apex of posterior to apex of anterior process; normal is 20 - 40 degrees; abnormal if < 20 degrees

150
Q

Hard signs of penetrating vascular injury (5)

A

arterial bleeding, shock, large pulsatile and expanding mass, new palpable thrill or audible bruit, distal ischemia

151
Q

soft signs of penetrating injury

A

minor bleeding, small stable hematoma, injury to nerve, proximity of tract to major vessels

152
Q

MGMT for penetrating extremity injury

A

if + hard signs, immediate OR exploration; if soft signs, CT angio

153
Q

definition of syndesmosis orthopedic injuries

A

sydnesmosis tear between tibia and fibula

154
Q

MOI for syndesmosis injuries

A

rotational force where ER of ankle +/- hyper dorsiflexion, overstretching this area between distal tibia and fibula

155
Q

physical exams for syndesmosis injuries

A

toe walking (prevent painful dorsiflexion), squeeze/hopkin test: tibia and fibula squeezed together at mid calf-level, if +, pain is felt at syndesmosis located at distal tibia and fibular junction; ER test: knee flexed at 90 degrees, hold pt’s foot and ER with small amount of dorsiflexion, if pain elicited + test

156
Q

xray findings for syndesmosis injuries

A

normal, can have decreased tibio-fibular overlap (< 6 mm in AP or < 1 mm on mortise); increased medial clear space (> 4mm)

157
Q

ED MGMT of syndesmosis injuries

A

non weightbearing aircast or backslab, ortho follow-up; r/o associated ankle injuries, 5th metatarsal injuries, proximal fibular fracture (maisonneuve)

158
Q

MOI distal biceps tendon rupture

A

construction workers or weightlifters with chronic repetitive microtrauma causing weakning tendon + sudden massive eccentric contraction

159
Q

Physical findings for bicep rupture

A

“popeye sign” - bulge in elbow flexion, ecchymosis on anterior aspect of elbow, decreased force of supination +/- pain with supination, Hook sign: use index finger, go lateral to insertion of biceps and hook finger around; if not able to, likely rupture

160
Q

MOI proximal biceps tendon rupture

A

seen in elderly patients due to age-related tendon and RC symptoms, no acute injury

161
Q

ED MGMT of biceps rupture

A

immobilization, refer to ortho

162
Q

ED MGMT of proximal biceps injury

A

physiotherapy

163
Q

quadriceps rupture sx

A

triad of acute knee pain, inability to extend knee, suprapatellar gap

164
Q

associated injuries with quads tendon rupture

A

patellar fracture, patellar tendon rupture

165
Q

Physical findings with quadriceps tendon rupture

A

failed SLR (unable to lift leg up), palpable gap betwen tendon and above the knee (suprapatellar gap)

166
Q

Xray findings for quadriceps rupture

A

patella baja (patella rides lower than usual); patellar alta (patella rides higher than usual - seen with patellar tendon rupture

167
Q

ED MGMT for quadriceps injuries

A

zimmer splint (knee immobilizer) with orthopaedics follow-up in few days

168
Q

injuries not requring zimmer splint

A

meniscal tears, ACl, MCL and PCL injuries

169
Q

gastrocnemius tears MOI

A

jumping or running from hill, weekend warrior

170
Q

difference between gastroc tear vs. DVT

A

swelling isolated to medial aspect of leg (DVT is entire leg), palpable divot bewteen junction of gastrocnemius and tendon with complete tear, bruising seen

171
Q

physical findings with gastroc tears

A

maximal tenderness at medial musculotendinous junction, van see visible defect in medial aspect of gastrocs; + calf raise test

172
Q

calf raise test

A

patient stands and plantar flexes one ankle so they can stand up on their tiptoes with one leg; if + but can complete the test, then it is likely gastroc tear; if unable to complete test, consider achilles tear

173
Q

imaging for gastroc tears

A

none, ultrasound as outpt

174
Q

ED MGMT for gastroc tears

A

conservative, early weight bearing, can consider ankle stirrup for comfort

175
Q

bloody airway approach in trauma

A

use direct with bougie; do not use video!

176
Q

definition of rapid sequence induction

A

paralytic and sedative at the same time

177
Q

vasopressors in trauma

A

no role unless neurogenic shock

178
Q

high-risk factor of mortality in trauma

A

hypotension! just one episode can result in poor outcome thus take hypotension seriously even if it normalizes

179
Q

metabolic acidosis in trauma etiology

A

secondary to hypo-perfusion (lactate and bicarb); decrease of acidosis can be quantified by base deficit; the greater base deficit, the higher the risk!

180
Q

“CRUMP” factor for need for operative intervention in trauma

A

sBP < 105, +FAST, and base deficit > 6

181
Q

continuous care of trauma patients

A

serial BW: hematocroit, lactate, EtCO2; hematocrit is surrogate for occult bleeding

182
Q

occult shock sources

A

retroperitoneum, chest, abdo, pelvic fractures

183
Q

“seatbelt sign”

A

contusion corresponding to seatbelt, increased risk for intestinal and intraabdominal injuries

184
Q

investigations for occult bleeding

A

CXR, FAST, pelvic xray

185
Q

FAST Exam drawbacks

A

< 200 cc of blood, mesenteric or bowel hematoma, diaphragmatic and pncreatic injuries

186
Q

FAST Exam sensitivity and specificity

A

good specificty, poor sensitivity

187
Q

5 Key Componenets of damage control in trauma resuscitation

A

hypothermia (bair huggers, level 1 infuser), permissive hypotension (allow for thrombus formation of injured vessels; target sBP 90- 100 except for head injuries (1 episode of hypotnestion associated with mortality), early use of blood products (only 1L if possible), rapid and early correction of coagulopathy, damage control surgery (abdomenpacking, etc.)

188
Q

indications for MTP

A

if you need 3+ units of blood, base deficit > 5, INr > 1.5, hemoperitoneum

189
Q

CRASH-2 Trial results

A

TXA reduced massive transfusion and reduced mortality (1%); TXA 1 g given over 10 min then 1g infusion IV over q8hrs

190
Q

CSpine injury guidelines in trauma

A

DO NOT USE ANY OF THEM! these guidelines are only for non-high risk mechanisms; CT C-spine if concerned, can consider MRI if normal CT but pain

191
Q

CT chest in trauma indications

A

only if suspicious of aortic or thoracic injuries as CXR isssensitive for hemothorax and PTX

192
Q

indication for pan scan in trauma

A

if intubated and cannot be assessed

193
Q

thoracic aortic injuries MOI in trauma

A

high-energy, lateral pevlic fractures, fall from height, anterior-posterior deceleration

194
Q

blunt cardiac injury in trauma

A

myocardial contusion, free wall rupture, valvular injury, peicardial injury

195
Q

rib fractures in eldery patients approach

A

associatd with high mortality if > 65yo, complications of atelectasis PNA; ED MGMT: observe in ED, repeat CXR, consider admission

196
Q

pelvic stability exam

A

gentle inward compression of iliac crest; if mobile, do not let go

197
Q

sx of pelvic trauma

A

groin/scrotal pain, suprapubic swelling/hematoma, tenderness at symphysis pubis, blood at urethral meatus, distal peripheral neuropathy, +FAST pelvic fluid

198
Q

Classification for pelvic fractures

A

young-bruges classification; A-P compression: open book fracture ( widened pubic symphysis); higher risk of posterior pelvic structures involved (SI joint), lateral compression, vertical shear (MOI of fall from height, worst prognosis)

199
Q

Physical exam findings for

Anterior shoulder dislocation

A

Internally rotated, abducted, squaring of

Shoulders

200
Q

3 views for shoulder dislocation

A

AP View, scapula Y View, axillary

201
Q

Complications of anterior shoulder dislocation

A

Hills Sachs lesion (humeral head fracture), bankcroft (Glenoid ant-inf fracture)

202
Q

complications of compartment syndrome - name 2

A
  1. rhabdomyolysis –> renal failure form myoglobinuria 2. Volkmann’s contracture - ischemic necrosis of muscle resulting in fibrosis and calcification, seen in supracondylar fracture of humerus
203
Q

XRay findings for osteomyelitis (seen 10-12 days after)

A

soft tissue swelling, lytic bone destruction, periosteal reaction

204
Q

XRay findings for septic joint

A

early: normal, can show soft tissue swelling, joint space widening from localized edema; late: joint space narrowing and destruction of cartilage

205
Q

order of most common to least for septic joint

A

knee, hip, elbow, ankle, sternoclavicular joint

206
Q

findings for septic arthritis in joint aspirate

A

cloudy yellow fluid, WBC > 50 000, > 90% neutrophils, high protein (4.4+), +glucose is low

207
Q

RF for septic arthritis

A

age, prosthetic joint, recent joint surgery, skin infection/ulcer, IVDU, corticosteroid injection, immunocompromised (cancer DM, alcohol, RA)

208
Q

name 4 joints in shoulder

A

GH, AC, sternoclagicular, scapulothoracic

209
Q

passive ROM shoulder normal

A

forward flexion: 180; extension: 45; abduction 180, adduction: 45; IR - T4, ER: 45

210
Q

MGMT clavicle fractures

A

medial/middle third #: displaced > 2 cm, an consider ORIF; distal third: if displaced: ORIF

211
Q

complication of clavicle fractures

A

associated rib fractures, brachial plexus injuries, subclavian vessel, shoulder stiffness

212
Q

frozen shoulder “adhesive capsulitis” definition

A

progressive pain and stiffness of shoulder, usually self-resolves after 18 months

213
Q

MOI frozen shoulder

A

primary: idiopathic, associated with DM, resolves in 9 - 18 months; secondary: due to prolonged immobilization, trauma/MI/stroke

214
Q

what is CRPS

A

complex regional pain syndrome: painful conditions characterized by continuing regional pain that is disproportionate in time or degree to lesion/trauma; sx: pain, swelling, limited ROMthen changes in skin and bones

215
Q

Sx of frozen shoulder

A

diffuse shoulder pain and BOTH decreased active and passive ROM; pain worse at night preventing sleeping on the side, stiffness as pain subsides

216
Q

MGMT frozen shoulder

A

freezing phase: AROM, PROM with PT, NSAIDs, steroids; thawing phase: manipulation under anesthesia and early physiotherapy, arthroscopy for debridement/decompression

217
Q

RF for adhesive capsulitis

A

prolonged immobilization, female, age 50+, DM, cervical disc disease, hyperthyroidism, stroke, MI, trauma and surgery, autoimmune

218
Q

stages of adhesive capsulitis

A

freezing phase: gradual onset, diffse pain (6-9 months), frozen phase: decreased ROM impacts function (lasts 4-9 months), thawing phase: gradual return of motion

219
Q

proximal humeral fracture test/investigation

A

axillary nerve - deltoid contraction and skin over deltoid, XRays, CT scan

220
Q

classification of proximal humeral fractures

A

neers: 4 fracture locations/parts, displacement > 1 cm or angulation > 45 degrees,

221
Q

MGMT proximal humeral fractures

A

if nondisplaced and minimally displaced, broad arm sling immobilization, begin ROM on day 14 to prevent stiffness

222
Q

indications for operation for proximal humerus fractures

A

anatomic neck fractures, displaced, irreducible GH joint dislocation

223
Q

complications of humerus fractures

A

AVN, nerve palse (axillary), malunion, post-trauma arthritis, persistent pain and weakness, adhesive capsulitis

224
Q

MGMT humeral shaft fractures

A

generally non-operative; hanging cast with collar and cuff sling immobilization until swelling subsides then sarmiento functional brace, followed by RMOM

225
Q

complication of humeral shaft fractures

A

radial nerve palsy (usually recovers in 3-4 months), nonunion, decreased ROM, compartment syndrome

PGY1 (12 decks)

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