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Question 1

When are bowel sounds heard in chest?

Answer 1

diaphragm rupture

Question 2

Kehr’s sign

Answer 2

L shoulder pain, ruptured spleen

Question 3

Grey-Turners sign

Answer 3

ecchymosis on flank, RP bleed

Question 4

Cullen’s sign

Answer 4

ecchymosis around umbilicus, intraperitoneal bleeding

Question 5

Brudzinski’s sign

Answer 5

lift neck, legs raise; sign of meningeal irritation (bacterial meningitis, give ABX)

Question 6

Kernig’s sign

Answer 6

move legs up and out, neck and leg pain, sign of meningeal irritation

Question 7

Subarachnoid hemorrhage complications

Answer 7

hydrocephalus, rebleed, vasospasm

Question 8

SAH rebleed

Answer 8

7-10 days after initial bleed, peak incidence day 4-8; greatest cause of death; confirmed with CT scan; Amicar

Question 9

SAH vasospasm

Answer 9

5-7 days post bleed (not post op); diagnosed with transcranial doppler or arteriogram; hyponatremia

Question 10

Treatment of vasospasm

Answer 10

transluminal balloon angioplasty for select cases; avoid hypotension, maintain ICP 60-70, fluids, pressors; want systolic 160-200; Nimodipine (Ca chan blocker)

Question 11

Cushing’s triad

Answer 11

sign of brain herniation: increased systolic (widening pulse pressure), decreased HR, decreased RR

Question 12

Homonymous hemianopsia

Answer 12

loss of vision in half the field of each eye; opposite the side of problem; cranial nerve II damage

Question 13

Pupil changes before LOC changes in what type of herniation?

Answer 13

Uncal; most often type is epidural hematoma