Trauma

Question 1

Traumatic aortic injuries are typically caused by __ and happen at __

Answer 1

Traumatic aortic injuries are typically caused by decceleration trauma and happen at the aortic isthmus (where the ductus used to be, just distal to the subclavian takeoff)

Question 2

Widened mediastinum absolute value

Answer 2

”> 8 cm on CXR”

Question 3

Basically whenever you have a patient with traumatic aortic injury, they will be . . .

Answer 3

. . . supine

This can make it subtle to detect hemothorax on CXR, so have high suspicion

Question 4

Tracheal deviation in the setting of suspected aortic dissection

Answer 4

Suggests mediastinal hematoma

Question 5

Deep sulcus sign

Answer 5

Seen when a patient with pneumothorax is supine

Sulci are deeper than normal and often clear of lung markings

Question 6

Flail chest

Answer 6

Question 7

1st rib injury

Answer 7

Another marker of severe trauma

Worrying for aortic or tracheal injury

Question 8

Lung laceration

Answer 8

Question 9

“Blush” and active extravasation

Answer 9

Contrast leaking out

Question 10

Test of choice in suspected bladder rupture

Answer 10

CT cystogram

Question 11

Normal retrograde urethrogram

Answer 11

Question 12

Probably exam q’s

Question 13

When to do a CT cystogram vs retrograde urethrogram?

Answer 13

Multiple pelvic fractures: CT cystogram

Blood at urethral meatus: Retrograde urethrogram

Question 14

Fracture with more than two pieces

Answer 14

Comminuted

Question 15

Fx directions

Answer 15

Question 16

Relationship of fragment pieces

Answer 16

Question 17

Fractures associated with anterior shoulder dislocations

Answer 17

Question 18

Sail sign

Answer 18

Fluid pushes a fat pad away from the bone

Indicates joint effusion, which may be associated with a fracture

Recommend that the patient come back in 7-8 days for re-imaging.

Adults: Radial head fracture

Kids: Distal humeral condylar head fracture

Question 19

Bennett’s fracture

Answer 19

Question 20

Rolando fracture

Answer 20

Question 21

Gamekeeper’s thumb

Answer 21

Question 22

Mallet finger

Answer 22

Question 23

Boxer’s fracture

Answer 23

Displaced, angulated fx of 5th metacarpal

Question 24

Colles fracture

Answer 24

Question 25

Smith’s fracture

Answer 25

Opposite displacement of Colles fracture

Question 26

Montegga fracture

Question 27

Galeazzi fracture

Answer 27

Question 28

Scaphoid fracture

Answer 28

If you aren’t sure, have them come back in 7-10 days

Question 29

Fat-fluid level in the knee

Answer 29

Should raise concern for some type of fracture, even if you can’t see it

Particularly a tibial pleateau fracture

Question 30

Segond fracture

Answer 30

This patient needs an MRI!

Question 31

Whenever we see a fracture at the medial malleolus, there is probably. . .

Answer 31

. . . another fracture at the proximal fibula

So, get another radiograph

Question 32

Maisonneuve fracture

Answer 32

Question 33

Jones’ fracture

Answer 33

Question 34

Hangman’s fracture

Answer 34

Due to severe hyperextension injury

Question 35

Jefferson fracture

Answer 35

Question 36

Dens fracture

Answer 36

Question 37

Pathological fracture

Answer 37

Question 38

When to order an ankle x-ray, according to the Ottawa ankle rules

Answer 38

• The patient has pain near the malleolus and one of the following:
  
  • Is age 55 or older
  • Has tenderness at the edge of the tibia
  • Has tenderness at the tip of either maleolus
  • Has tenderness at the navicular bone*
  • Has tenderness at the cuboid*
  • Has tenderness at the 5th metatarsal base*
  • Inability to bear weight immediately following injury*
  • Inability to walk 4 steps in the ER*
• The starred ones are also an indication for foot x-ray

Question 39

Fracture descriptors

Answer 39

Question 40

Diagnosis of an occult (not visible on simple x-ray) hip fracture

Answer 40

MRI is the most sensitive, best option

If not available, CT can also work

Question 41

Names of major femur fractures

Answer 41

Question 42

Grading system for femur fractures (with associated treatments)

Answer 42

Question 43

Artery that supplies the femoral head

Answer 43

Profunda femoral artery

Question 44

Posterior shoulder dislocation

Answer 44

Question 45

Inferior shoulder dislocation

Answer 45