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BOARD REVIEW > Trauma > Flashcards

Trauma Flashcards

1
Q

Trauma
Decrease level of consciousness
Enlarging right pupil
Dx?

A

Uncal herniation with oculomotor nerve compression

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2
Q

Cranial nerve evaluated with corneal reflex test

A

Ophthalmic nerve
Trigeminal nerve
Facial nerve

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3
Q

Sensations spared in anterior cord syndrome

A

Position
Vibratory
Light touch

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4
Q

Airway control in patients with severe maxillofacial trauma

A

Cricothyroidotomy

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5
Q

Nerve should be avoided during pericardiotomy

A

Phrenic nerve

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6
Q

Plain film x-ray finding most suggestive of traumatic rupture of aorta

A

Deviation of esophagus >2cm to the right of spinous process of T4
(Requires nasogastric intubation to be demonstrated)

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7
Q

Indications for thoracotomy for hemothorax

A

1500cc out initially
>200cc/hr x 4hrs
Unstable
Incomplete drainage after two functional chest tubes

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8
Q

Landmarks for zones of the neck

A

I - below cricoid
II - cricoid to Angle of jaw
III - above angle of mandibale

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9
Q

Bacterial endocarditis, secondary to soft-tissue infections is most commonly caused by what organism

A

Ataphylococcus aureus
Staphylococcus epidermidis

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10
Q

Tarsal bone most commonly fractured

A

Calcaneus

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11
Q

Proper way to transport alan amputated digit

A

Stored on a saline moistened gauze, in a plastic bag and placed on ice

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12
Q

What variables are vital in determining the viability of a mangled (mutilated) extremity

A

Nerve integrity
Neuro function
Ability to achieve adequate revascularization
Ability to provide sof tissue coverage of exposed bone
Overall estimated functionality after recovery

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13
Q

MVA
Seat belt sign across neck
Ipsilateral ptosis
Pinpoint pupil
Dx?

A

Blunt carotid injury/dissection with associated Horner’s syndrome

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14
Q

MC route of successful suicide

A

Self-inflicted gunshot wound

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15
Q

Valvular abnormality most commonly seen in patients with blunt chest trauma

A

Aortic insufficiency

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16
Q

MC site of blunt esophageal rupture

A

Distal 3rd

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17
Q

Transmucosal burn withOUT muscle involvement

A

2nd degree corrosive esophageal burn

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18
Q

Stab wound @ 5th intercostal space
Hypotension
Water bottle sign chest xray

A

Pericardial tamponade

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19
Q

MC injured organ 2ndary to penetrating trauma to abdomen

A

Small bowel

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20
Q

Clinical hallmarks of abdominal compartment syndrome necessitating decompressive laparotomy

A

Oliguria
Elevated peak airway pressure (>35)
Decrese cardiac output
Dx confirmed with bladder pressure >30

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21
Q

Emergency tx for pt with Tension Pneumothorax

A

Needle decompression at the 2nd intercostal space in midclavicular line followed by thoracostomy tube

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22
Q

Most reliable test to identify patients with cardiac contusion who are at risk of complications

A

ECG

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23
Q

Blunt chest trauma
Holosystolic murmur
Distended neck vein
Dx?

A

Tricuspid valve disruption and right sided heart failure

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24
Q

Indication of Pringle maneuver

A

To demonstrate that Hepatic hemorrhage is coming from the Hepatic Artery of Portal Vein inflow, as opposed to the posterior extrahepatic veins or inferior vena cava

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25
Q

Tx of choice for patients with complex bile duct injury

A

Roux-en-Y CholedochoJejunostomy or a HepaticoJejunostomy

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26
Q

Most frequent indication for exploratory laparotomy following blunt trauma

A

Splenic injury

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27
Q

Organism most commonly associated with Overwhelming PostSplenectomy Sepsis (OPS)

A

Pneumococcus
Meningococcus
H influenza

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28
Q

Scorpion bites
Manifestations?
Tx?

A

Manifestations:
Neurotoxic effects
Hyperesthesia
Cardiac arrythmia
Muscle spasm
Seizure
incontinence

Tx: calcium IV (for spasm)
Anti-venin

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29
Q

Triad indicating damage control laparotomy with delayed re-exploration is best

A

Hypothermia
Coagulopathy
Acidosis

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30
Q

Most commonly missed injury with use of laparoscopy for evaluation of abdomen in trauma patients

A

Hollow viscus injury

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31
Q

Most rapid means of assessing intravascular volume status

A

Level of consciousness
Pulse

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32
Q

Triad of Hemobilia

A

GI bleed
Jaundice
RUQ pain

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33
Q

General management principles of venomous snake bites

A

Resuscitation
Antivenin if septic signs develop
Tetanus toxoid
Antihistamines

34
Q

Principles of tetanus immunization

A

Tetanus toxoid - immunization 3 doses
“Booster” is toxoid
Someone at risk also given antitetanus immunoglobulin as well as toxoid bec they may not yet immuned

35
Q

Injuries associated with inflation of air bags

A

Corneal abrasions
Keratitis
Face and neck abrasions
Cervical spine fractures

36
Q

Single most important determinant of outcome in patients following pancreatic injury

A

Presence of pancreatic ductal injury

37
Q

Transected sciatic nerve
Possible movement of lower extremity?

A

Flexion and ADDuction of thigh

38
Q

MC mechanism of burn to children less than 5 years of age

A

Scalding

39
Q

Most common cause of early instability in burn patients

A

Severe inhalation injury

40
Q

When does capillary permeability return to normal in a burned patient

A

During 2nd 24hr post burn

41
Q

Best way to determine adequate fluid resuscitation in burn victim

A

Urine output

42
Q

Goal UO patient suffered electrical burn and has reddish urine

A

100-150mL/hr

43
Q

Proper location of escharotomy in patients with circumferential full-thickness extremity burn

A

Mid-medial and mid-lateral lines, down to and just through subdermal fascial attachments

44
Q

Most accurate dx test for inhalation injury

A

Bronchoscopy

45
Q

Type of infection are peripheral hemorrhagic infarcts of ecthyma gangrenosum specific for?

A

Pseudomonas

46
Q

MC fungal organism in burn

A

Phycomycetes
Aspergillus

47
Q

Topical antimicrobial agent DOES NOT penetrate eschars

A

Silver nitrate

48
Q

Major mediators of hypermetabolic response in burn patients

A

Catecholamines

49
Q

T/F
Thermal injury suppress thyroid hormone

A

True

50
Q

Predominant cytokines that promote wound healing and amplify the hypermetabolic response

A

IL-1
IL-6
TNF
IFN-gamma

51
Q

Best source of nonprotein calories for a burn patient

A

Carbohydrates

52
Q

Hallmark of electrical injury

A

Extensive deep tissue damage far out of proportion to the visible cutaneous burn

High voltage – rule out myocardial damage (ECG/troponin)

Obtain ophtha exam – cataracts

R/o large muscle group necrosis (CK level and urine myoglobin)

53
Q

Hallmark of lightning injury

A

Tree-like pattern of erythema on skin
Neuro deficit that often resolve spontaneously w/in 24hrs

54
Q

HydroFluoric acid burn

A

Hydrogen ion – protein coagulation
Free fluoride ion – liquefaction and penetrate deeply to form salts with magnesium and calcium

Tx: calcium gluconate to burn wound

55
Q

TOC with phenol contact

A

50% solution of polyethylene glycol followed by copious water irrigation

56
Q

MC pathogens inducing necrotizing soft-tissue infection

A

Group A beta hemolytic Streptococcus and Clostridium perfringes

57
Q

MC organism isolated from diabetic foot ulcers

A

Gram positive cocci
Usually polymicrobial so treat witb antibiotics againts gram positive, negatives and anaerobes

58
Q

Dermal ischemia from capillary occlusion

A

Decubitus ulceration

59
Q

What is the predictive value of a test

A

Percentage of positive results that are true positives

60
Q

Why beta blockes not used alone in perioperative care of patients with pheochromocytoma

A

Unopposed alpha stimulation may provoke hypertensive crisis

61
Q

Hypertensive medications classically cause withdrawal hypertension and therefore should not be stopped prior to surgery

A

Beta blockerd and Clonidine

62
Q

Brown recluse spider bites
Bulls eye wound appearance
Tx?

A

oral and topical DAPSONE

63
Q

Electrolyte imbalance in digitalis toxicity

A

Hypokalemia

64
Q

Neuroendocrine tumor from dermal “pressure receptor” presenting in sun-exposed areas as a purple nodule or plaque

A

Merkle cell carcinoma

65
Q

Medications most notorious for inducing toxic epidermal necrolysis

A

Sulfa drugs

66
Q

What is considered clean contaminated wound?

A

Alimentary
Respiratory
Genitourinary tracts
Under controlled conditions and w/o unusual contamination, minor break in technique or mechanical drainage

67
Q

When should sutures be removed from areas of good blood supply (face and neck)?

A

Within 4 or 5 days if the wound is not under tension

68
Q

Difference between sensitivity and specificity

A

Sensitivity - ability to detecr a disease
- tp/tp + fn (sensitivity test is low fn
- positive in disease

Specificity - ability to say that no disease is present
- tn/tn + fn – low fp
-negative in health

69
Q

Type of suture causes least amount of tension on wound edge

A

Interrupted perpendicular sutures

70
Q

Most common site of perforation of the surgeon’s glove during surgery

A

Nondominant index finger

71
Q

Prophylactic antibiotic of choice prior to appendectomy

A

Cefotetan or cefoxitin

72
Q

Fever
Myalgia, arthralgia
Wt loss
Pain over inflammed vessel

Late: transient ischemic attacks
Leg claudication, angina

Female 30-45yo
Management strroids/ anti inflam

A

Takayasu’s arteritis

73
Q

Angiographic finding in Takayasu’s disease

A

Segmental dilatation
Stenosis
Occlusions

74
Q

Flu like prodrome w fever
Malaise, wt loss, scalp tenderness
Headache, myalgia
Pain over occipital or temporal arteries
Jaw claudication, eye symptoms

Occurs in OLDER patients
Occlusive disease in distal upper extremity arteries rather central arteries

A

Giant cell (temporal) arteritis

75
Q

Occlusion of terminal retinal arterioles from atherosclerotic emboli arising from carotid bifurcation

A

Amaurosis fugax (transient monocular blindness) in patient with temporal arteritis

76
Q

Brabches of external carotid artery

A

Proximal to distal:
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Internal maxillary
Temporal arteries

77
Q

Neuropathic ulcers under metatarsal head
Decreased reflexes (achilles)
Sensory loss
Bone deformity w collapsed plantar arch (charcot foot)

A

Diabetic neuropathy

78
Q

Role of Carotid body

A

Body (@ carotid bifurcation) is a chemoreceptor that detects increased CO2/H+ and triggers tachycardia and vasoconstriction

79
Q

Role of carotid sinus

A

Sinus (along Internal carotid) detects increased BP and triggers bradycardia and BP fall

80
Q

Anything that marrows the outlet such as muscular hypertrophy, fibrous tissue , cervical ri , scar tissue or fracture callus, can impinge on one or more of the structures within thoracic outlet and cause symptoms

A

Thoracic outlet syndrome

81
Q

Virchow’s triad

A

Stasis
Endothelial cell injury
Hypercoaguable state

BOARD REVIEW (19 decks)

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