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Sports Medicine > Thorax/Abdomen > Flashcards

Thorax/Abdomen Flashcards

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1
Q

for a sternal fracture with possible intrathoracic trauma, what are the first two steps in workup/eval?

A

CXR and EKG

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2
Q

why should displaced sternal fractures be relocated in the hospital?

A

due to possible associated intrathoracic trauma - reduction should be done during cardiac monitoring

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3
Q

directionally, what is the most common type of SC joint dislocation?

A

anterior

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4
Q

what type of chest dislocation causes 25-30% risk of injury to vital structures traversing the thoracic outlet and has 12.5% mortality rate?

A

posterior SC joint dislocation

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5
Q

which xray view should be obtained to evaluate for SC joint dislocation?

A

Serendipity view

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6
Q

how is a typical Grade I/II SC joint injury treated?

A

sling as needed for pain, avoiding stress on joint for 2-4 weeks, followed by early functional therapy

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7
Q

what injection therapies can be offered for patients with chronic SCJ dislocation?

A

corticosteroid / prolotherapy

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8
Q

a violent muscle contraction of the abdomen can cause what type of rib fracture? why?

A

avulsion fracture of attachments of the external obliques to the lower three ribs / floating ribs

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9
Q

what is the term given to fracture of at least 3 consecutive ribs, each in two locations, causing free floating segment of chest wall?

A

flail chest

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10
Q

what modality is more sensitive than conventional radiography in the initial eval of suspected rib fracture?

A

ultrasound

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11
Q

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?

A

bone stimulator

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12
Q

what injection type can be used for acute treatment of pain due to rib fracture?

A

intercostal nerve block - injecting lidocaine or bupivacaine just below lower border of the fractured rib

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13
Q

s/p first rib fracture, if excessive callus forms, what are two possible complications?

A

TOS / Horner’s syndrome

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14
Q

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

A

true

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15
Q

what is the typical return to play time after uncomplicated rib fracture?

A

3-8 weeks

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16
Q

what is the name of the ligament that attaches rib to sternum and rib, respectively?

A

sternocostal ligament / costochondral ligament

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17
Q

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?

A

slipping tib / costochondral separation

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18
Q

what is the normal return to play time for a slipping rib / costochondral sprain or separation?

A

9-12 weeks (slow healing)

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19
Q

what muscle is the most important adductor and internal rotator of the shoulder

A

pectoralis major

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20
Q

describe the insertion of the pectoralis major muscle on the humerus in relationship to the biceps groove

A

inserts lateral to the biceps groove

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21
Q

how are partial tears of the pec major treated?

A

conservatively with ice, sling for comfort, activity restriction

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22
Q

by how many weeks after a partial pec major tear should resisted strengthening exercises begin?

A

6-8 weeks

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23
Q

after a surgery for grade III pec major tear, how long should you immobilize to protect repair?

A

4-6 weeks

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24
Q

what condition is marked by protein and blood leaking into the alveolar fluid, causing atelectasis and consolidation?

A

pulmonary contusion

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25
Q

what is the hallmark clinical sign of pulmonary contusion?

A

hypoxemia

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26
Q

what is the treatment for pulmonary contusion?

A

supportive therapy, frequent monitoring, pain control, early mobilization, oxygen support

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27
Q

t/f those who recover even from severe pulmonary contusions do not suffer any significant late respiratory problems

A

true

28
Q

what is the typical time of symptom resolution after pulmonary contusion?

A

2-10 days

29
Q

a patient experiences chest trauma followed by hypotension, dullness to percussion of the chest, and decreased breath sounds. what is the most likely diagnosis?

A

hemothorax

30
Q

for a minimal (15-30%) PTX, what is the treatment?

A

serial examinations, monitoring and CXR

31
Q

vigorous activities and air travel should be avoided for how long after treatment for PTX?

A

2-3 weeks

32
Q

what is the difference between myocardial contusion and commotio cordis?

A

myocardial contusion - structural damage
commotio cordis - rhythm abnormality due to mechanical impact without structural damage

33
Q

a patient experiences blunt chest trauma , after which pain improves with oxygen but not with nitroglycerin. what is the diagnosis?

A

myocardial contusion

34
Q

what is the treatment for mild myocardial contusion?

A

admit for monitoring with tele to monitor for dysrhythmia

35
Q

how is pulsus paradoxus defined?

A

drop in blood pressure > 10mm Hg on inspiration

36
Q

what is Beck’s triad? and what condition is it found in?

A

hypotension, JVD, and distant heart sounds - found in cardiac tamponade

37
Q

an ECG showing electrical alternans, sinus tachycardia, low voltage and diffuse PR depression is indicative of what condition?

A

cardiac tamponade

38
Q

what is the treatment for coronary artery dissection?

A

pain control, nitroglycerin, beta blocker, statin, ASA, anticoagulation

39
Q

what are the three sites of thoracic outlet syndrome?

A

supraclavicular, subclavicular, and infraclavicular

40
Q

what trunk of the brachial plexus is most commonly affected by thoracic outlet syndrome?

A

lower trunk

41
Q

describe the Adson maneuver for TOS testing

A

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

42
Q

describe the Wright maneuver for TOS testing?

A

arm abducted, hand brought over head, elbow and arm in the coronal plane

43
Q

describe the Roos test for TOS testing

A

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

44
Q

t/f trigger points in the supraspinous fossa, rhomboids, levator scapula and infraspinatus can cause pain to radiate down arm

A

true

45
Q

what two XR studies can be helpful in the evaluation for thoracic outlet syndrome?

A

XR c spine and XR chest to evaluate lung apex

46
Q

what type of injection can be helpful for diagnosis of nTOS

A

anterior scalene injection

47
Q

what is the success rate for conservative management of thoracic outlet syndrome?

A

50-90%

48
Q

when is surgery an option for TOS?

A

if diagnosis of TOS is firm and conservative therapy for 4-6 months is not effective

49
Q
A
50
Q

what is the most common MOI for Paget Schroetter syndrome?

A

repetitive overhand motion causing trauma to a vessel such as hyperabduction and external rotation

51
Q

Paget Schroetter syndrome, or effort thrombosis, effects what two veins?

A

axillary or subclavian vein

52
Q

what lab should you order first when concerned about Paget Schroetter syndrome?

A

D - dimer

53
Q

for a patient that presents with Paget Schroetter syndrome ongoing for > 2 weeks, what is the hallmark treatment other than nsaids, ice for pain?

A

anticoagulation - DOAC x 3 months

54
Q

t/f no contact sports is allowed while on anticoagulation

A

true

55
Q

what is the Cullen sign?

A

bluish discoloration in the periumbilical region

56
Q

what is the most frequent cause of death related to abdominal injury in sports?

A

splenic rupture

57
Q

what is the most commonly injured organ in sports?

A

spleen

58
Q

a splenic injury results in referred pain to the left or right shoulder. what is this sign called?

A

Kehr sign

59
Q

Neck pain can result from splenic rupture resulting in phrenic nerve pressure. what is this sign called?

A

Saegesser sign

60
Q

what is the Ballance sign?

A

fixed dullness in the left flank (splenic rupture)

61
Q

after splenectomy, what 3 vaccinations need to be given?

A
  1. strep pneumoniae
  2. hemophilus influenze
  3. neisseria meningitides
62
Q

what is the minimum RTP time for a splenic rupture that was treated non operatively?

A

3 months

63
Q

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?

A

start IVF and place in Trendelenburg position

64
Q

what two imaging methods evaluate the pancreatic duct?

A

MRCP / ERCP

65
Q

a femoral hernia will occur in what relative direction to the femoral artery?

A

medial to the femoral artery

66
Q
A

Sports Medicine (14 decks)

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