Trauma

Question 1

Fever within 4 hours of transfusion reaction

Answer 1

Febrile non-hemolytic transfusion reaction (due to recipient antibodies reacting with donor leukocytes, causing cytokine release)

Question 2

Cause of febrile non-hemolytic transfusion reaction

Answer 2

Reaction of recipient antibodies with donor leukocytes, causing cytokine release

Question 3

Fever, malaise, hyperbilirubinemia 3-10 days after blood transfusion

Answer 3

Delayed immune hemolytic reaction

Question 4

R time (TEG)

Answer 4

Time to start of clot formation

Question 5

K value (TEG)

Answer 5

Time from start of clot formation to a set strength

Question 6

Alpha angle (TEG)

Answer 6

Angle from the end of R time to K value

Question 7

If elevated K time on TEG, what product should you give

Answer 7

Cryoprecipitate

Question 8

If maximum amplitude is low on TEG, what should you give

Answer 8

Platelets

Question 9

J waves on EKG

Answer 9

Early finding of hypothermia (can lead to ventricular fibrillation and asystole)

Question 10

Most common mechanism for blunt cardiac injury

Answer 10

Rapid deceleration

Question 11

Most common arrhythmia in blunt cardiac injury

Answer 11

Sinus tach

Question 12

R time is prolonged on TEG - what blood products to give?

Answer 12

FFP

Question 13

If alpha angle is abnormal on TEG, what blood product should you give

Answer 13

Cryoprecipitate

Question 14

Operative approach to get exposure to proximal left carotid

Answer 14

Median sternotomy with left neck extension

Question 15

First degree frostbite

Answer 15

Superficial: numbness and edema -> firm plaque. Spontaneous healing in 1-4 weeks

Question 16

Second degree frostbite

Answer 16

Partial-thickness: milky-white blisters. Takes 2-4 weeks to heal

Question 17

Third degree frostbite

Answer 17

Full thickness: hemorrhagic blister formation, nonviable skin forms eschar, can result in limb/tissue loss
1-3 months to heal

Question 18

Fourth degree frostbite

Answer 18

Extends to the bone, tissues are black/mummified on presentation

Question 19

Hyperkalemia after blood transfusion - cause?

Answer 19

Transfusion of stored packed RBCs (leakage of K out of cells occurs each day)

Question 20

Most common underlying cause of warfarin-induced skin necrosis

Answer 20

Protein C deficiency (more common than protein S deficiency)

Question 21

DPL is better than CT at detecting which kind of injury?

Answer 21

Hollow viscous injury (but is poor at detecting solid organ injury)

Question 22

Contraindications for doing DPL

Answer 22

Pregnancy and hemodynamic instability

Question 23

Type of incision for repairing extraperitoneal bladder injuries

Answer 23

Pfannensteil

Question 24

Type of incision for repairing intraperitoneal bladder injuries

Answer 24

Midline

Question 25

Operative technique for repairing bladder injuries

Answer 25

In two layers using absorbable suture: mucosa and muscularis, then muscularis and serosa

Question 26

Where is erythropoeitin produced in fetuses and adults

Answer 26

Fetus: liver Adults: kidney

Question 27

Curreri formula (kcal per day of nutrition for burn patients)

Answer 27

(25kcal x kg) + (40kcal x %TBSA) [First degree burns are not included]

Question 28

Operative technique to obtain exposure of zone 3 neck carotid injury

Answer 28

Divide posterior belly of digastric - if still no control, do balloon occlusion with Fogarty catheter

Question 29

Fracture at surgical neck of humerus risks which nerve injury

Answer 29

Axillary nerve (+ posterior circumflex humeral artery)

Question 30

If decreased clotting strength on ROTEM, but FIBTEM MCF is normal, what should you give

Answer 30

Platelets

Question 31

If decreased clotting strength on ROTEM and FIBTEM MCF is also low, what should you give

Answer 31

Cryoprecipitate

Question 32

Reversal for tPA

Answer 32

Cryoprecipitate (Aminocaproic acid if cryo is unavailable)

Question 33

Management of supracondylar fracture of humerus in kids

Answer 33

Closed reduction and percutaneous pinning

Question 34

Volksman contracture

Answer 34

Potential complication of improper treatment of supracondylar humeral fracture - kinks brachial artery and leads to compartment syndrome and withered hand

Question 35

Most commonly injured nerve in anterior shoulder dislocation

Answer 35

Axillary nerve