Thorax/Abdomen

Question 1

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

Answer 1

CXR and EKG

Question 2

why should displaced sternal fractures be relocated in the hospital?

Answer 2

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

Question 3

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

Answer 3

anterior

Question 4

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

Answer 4

posterior SC joint dislocation

Question 5

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

Answer 5

Serendipity view

Question 6

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

Answer 6

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

Question 7

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

Answer 7

corticosteroid / prolotherapy

Question 8

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

Answer 8

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

Question 9

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

Answer 9

flail chest

Question 10

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

Answer 10

ultrasound

Question 11

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?

Answer 11

bone stimulator

Question 12

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

Answer 12

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

Question 13

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

Answer 13

TOS / Horner’s syndrome

Question 14

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

Answer 14

true

Question 15

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

Answer 15

3-8 weeks

Question 16

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

Answer 16

sternocostal ligament / costochondral ligament

Question 17

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?

Answer 17

slipping tib / costochondral separation

Question 18

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

Answer 18

9-12 weeks (slow healing)

Question 19

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

Answer 19

pectoralis major

Question 20

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

Answer 20

inserts lateral to the biceps groove

Question 21

how are partial tears of the pec major treated?

Answer 21

conservatively with ice, sling for comfort, activity restriction

Question 22

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

Answer 22

6-8 weeks

Question 23

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

Answer 23

4-6 weeks

Question 24

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

Answer 24

pulmonary contusion

Question 25

what is the hallmark clinical sign of pulmonary contusion?

Answer 25

hypoxemia

Question 26

what is the treatment for pulmonary contusion?

Answer 26

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

Question 27

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

Answer 27

true

Question 28

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

Answer 28

2-10 days

Question 29

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

Answer 29

hemothorax

Question 30

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

Answer 30

serial examinations, monitoring and CXR

Question 31

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

Answer 31

2-3 weeks

Question 32

what is the difference between myocardial contusion and commotio cordis?

Answer 32

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

Question 33

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

Answer 33

myocardial contusion

Question 34

what is the treatment for mild myocardial contusion?

Answer 34

admit for monitoring with tele to monitor for dysrhythmia

Question 35

how is pulsus paradoxus defined?

Answer 35

drop in blood pressure > 10mm Hg on inspiration

Question 36

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

Answer 36

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

Question 37

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

Answer 37

cardiac tamponade

Question 38

what is the treatment for coronary artery dissection?

Answer 38

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

Question 39

what are the three sites of thoracic outlet syndrome?

Answer 39

supraclavicular, subclavicular, and infraclavicular

Question 40

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

Answer 40

lower trunk

Question 41

describe the Adson maneuver for TOS testing

Answer 41

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

Question 42

describe the Wright maneuver for TOS testing?

Answer 42

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

Question 43

describe the Roos test for TOS testing

Answer 43

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

Question 44

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

Answer 44

true

Question 45

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

Answer 45

XR c spine and XR chest to evaluate lung apex

Question 46

what type of injection can be helpful for diagnosis of nTOS

Answer 46

anterior scalene injection

Question 47

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

Answer 47

50-90%

Question 48

when is surgery an option for TOS?

Answer 48

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

Question 50

what is the most common MOI for Paget Schroetter syndrome?

Answer 50

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

Question 51

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

Answer 51

axillary or subclavian vein

Question 52

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

Answer 52

D - dimer

Question 53

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

Answer 53

anticoagulation - DOAC x 3 months

Question 54

t/f no contact sports is allowed while on anticoagulation

Answer 54

true

Question 55

what is the Cullen sign?

Answer 55

bluish discoloration in the periumbilical region

Question 56

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

Answer 56

splenic rupture

Question 57

what is the most commonly injured organ in sports?

Answer 57

spleen

Question 58

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

Answer 58

Kehr sign

Question 59

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

Answer 59

Saegesser sign

Question 60

what is the Ballance sign?

Answer 60

fixed dullness in the left flank (splenic rupture)

Question 61

after splenectomy, what 3 vaccinations need to be given?

Answer 61

1. strep pneumoniae 2. hemophilus influenze 3. neisseria meningitides

Question 62

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

Answer 62

3 months

Question 63

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?

Answer 63

start IVF and place in Trendelenburg position

Question 64

what two imaging methods evaluate the pancreatic duct?

Answer 64

MRCP / ERCP

Question 65

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

Answer 65

medial to the femoral artery