Thorax/Abdomen Flashcards
for a sternal fracture with possible intrathoracic trauma, what are the first two steps in workup/eval?
CXR and EKG
why should displaced sternal fractures be relocated in the hospital?
due to possible associated intrathoracic trauma - reduction should be done during cardiac monitoring
directionally, what is the most common type of SC joint dislocation?
anterior
what type of chest dislocation causes 25-30% risk of injury to vital structures traversing the thoracic outlet and has 12.5% mortality rate?
posterior SC joint dislocation
which xray view should be obtained to evaluate for SC joint dislocation?
Serendipity view
how is a typical Grade I/II SC joint injury treated?
sling as needed for pain, avoiding stress on joint for 2-4 weeks, followed by early functional therapy
what injection therapies can be offered for patients with chronic SCJ dislocation?
corticosteroid / prolotherapy
a violent muscle contraction of the abdomen can cause what type of rib fracture? why?
avulsion fracture of attachments of the external obliques to the lower three ribs / floating ribs
what is the term given to fracture of at least 3 consecutive ribs, each in two locations, causing free floating segment of chest wall?
flail chest
what modality is more sensitive than conventional radiography in the initial eval of suspected rib fracture?
ultrasound
what modality is approved for treatment of a rib stress fracture if after 3 months from diagnosis the fracture line has not healed after non surgical management?
bone stimulator
what injection type can be used for acute treatment of pain due to rib fracture?
intercostal nerve block - injecting lidocaine or bupivacaine just below lower border of the fractured rib
s/p first rib fracture, if excessive callus forms, what are two possible complications?
TOS / Horner’s syndrome
t/f for rib fracture RTP is guided by no pain with palpation, no use of analgesics, full ROM thoracic cage, and ability to sprint/twist without significant discomort
true
what is the typical return to play time after uncomplicated rib fracture?
3-8 weeks
what is the name of the ligament that attaches rib to sternum and rib, respectively?
sternocostal ligament / costochondral ligament
what chest condition is characterized by reproducible pain / clicking when curling fingers under costochondral junction in question and lifting the region superiorly and anteriorly to palpate subluxation?
slipping tib / costochondral separation
what is the normal return to play time for a slipping rib / costochondral sprain or separation?
9-12 weeks (slow healing)
what muscle is the most important adductor and internal rotator of the shoulder
pectoralis major
describe the insertion of the pectoralis major muscle on the humerus in relationship to the biceps groove
inserts lateral to the biceps groove
how are partial tears of the pec major treated?
conservatively with ice, sling for comfort, activity restriction
by how many weeks after a partial pec major tear should resisted strengthening exercises begin?
6-8 weeks
after a surgery for grade III pec major tear, how long should you immobilize to protect repair?
4-6 weeks
what condition is marked by protein and blood leaking into the alveolar fluid, causing atelectasis and consolidation?
pulmonary contusion
what is the hallmark clinical sign of pulmonary contusion?
hypoxemia
what is the treatment for pulmonary contusion?
supportive therapy, frequent monitoring, pain control, early mobilization, oxygen support
t/f those who recover even from severe pulmonary contusions do not suffer any significant late respiratory problems
true
what is the typical time of symptom resolution after pulmonary contusion?
2-10 days
a patient experiences chest trauma followed by hypotension, dullness to percussion of the chest, and decreased breath sounds. what is the most likely diagnosis?
hemothorax
for a minimal (15-30%) PTX, what is the treatment?
serial examinations, monitoring and CXR
vigorous activities and air travel should be avoided for how long after treatment for PTX?
2-3 weeks
what is the difference between myocardial contusion and commotio cordis?
myocardial contusion - structural damage
commotio cordis - rhythm abnormality due to mechanical impact without structural damage
a patient experiences blunt chest trauma , after which pain improves with oxygen but not with nitroglycerin. what is the diagnosis?
myocardial contusion
what is the treatment for mild myocardial contusion?
admit for monitoring with tele to monitor for dysrhythmia
how is pulsus paradoxus defined?
drop in blood pressure > 10mm Hg on inspiration
what is Beck’s triad? and what condition is it found in?
hypotension, JVD, and distant heart sounds - found in cardiac tamponade
an ECG showing electrical alternans, sinus tachycardia, low voltage and diffuse PR depression is indicative of what condition?
cardiac tamponade
what is the treatment for coronary artery dissection?
pain control, nitroglycerin, beta blocker, statin, ASA, anticoagulation
what are the three sites of thoracic outlet syndrome?
supraclavicular, subclavicular, and infraclavicular
what trunk of the brachial plexus is most commonly affected by thoracic outlet syndrome?
lower trunk
describe the Adson maneuver for TOS testing
abduct the arm, externally rotate, head toward side of lesion, have the patient take a deep breath and palpate the radial pulse - positive if radial pulse diminishes
describe the Wright maneuver for TOS testing?
arm abducted, hand brought over head, elbow and arm in the coronal plane
describe the Roos test for TOS testing
abduct the arms to 90 degrees, externally rotate the shoulder and flex elbows to 90 degrees, hands open and closed for 3 minutes to reproduce symptoms
t/f trigger points in the supraspinous fossa, rhomboids, levator scapula and infraspinatus can cause pain to radiate down arm
true
what two XR studies can be helpful in the evaluation for thoracic outlet syndrome?
XR c spine and XR chest to evaluate lung apex
what type of injection can be helpful for diagnosis of nTOS
anterior scalene injection
what is the success rate for conservative management of thoracic outlet syndrome?
50-90%
when is surgery an option for TOS?
if diagnosis of TOS is firm and conservative therapy for 4-6 months is not effective
what is the most common MOI for Paget Schroetter syndrome?
repetitive overhand motion causing trauma to a vessel such as hyperabduction and external rotation
Paget Schroetter syndrome, or effort thrombosis, effects what two veins?
axillary or subclavian vein
what lab should you order first when concerned about Paget Schroetter syndrome?
D - dimer
for a patient that presents with Paget Schroetter syndrome ongoing for > 2 weeks, what is the hallmark treatment other than nsaids, ice for pain?
anticoagulation - DOAC x 3 months
t/f no contact sports is allowed while on anticoagulation
true
what is the Cullen sign?
bluish discoloration in the periumbilical region
what is the most frequent cause of death related to abdominal injury in sports?
splenic rupture
what is the most commonly injured organ in sports?
spleen
a splenic injury results in referred pain to the left or right shoulder. what is this sign called?
Kehr sign
Neck pain can result from splenic rupture resulting in phrenic nerve pressure. what is this sign called?
Saegesser sign
what is the Ballance sign?
fixed dullness in the left flank (splenic rupture)
after splenectomy, what 3 vaccinations need to be given?
- strep pneumoniae
- hemophilus influenze
- neisseria meningitides
what is the minimum RTP time for a splenic rupture that was treated non operatively?
3 months
you suspect splenic rupture in a patient who is now mildly hypotensive. in addition to transport to ER facility, what two things should you do now?
start IVF and place in Trendelenburg position
what two imaging methods evaluate the pancreatic duct?
MRCP / ERCP
a femoral hernia will occur in what relative direction to the femoral artery?
medial to the femoral artery
