Trauma

Question 1

Mesenteric avulsion is an example of what kind of injury?

Answer 1

deceleration injury (more common than aortic rupture)

Question 2

A seat belt sign across the abdomen should raise suspicion of what kind of severe injury?

Answer 2

hollow viscus injury

Question 3

If a rushing sound is audible during inspiration, immediate management requires…

Answer 3

closure of the hole with sterile dressing with intercostal chest drain! Or 3 sided bandage

Question 4

Massive hemoperitoneum from the liver due to stellate hepatic injuries. Next step?

Answer 4

1) packing the liver
2) pringle maneuver (insert finger into Winslow foramen and other into the lesser omentum and squeeze proper hepatic artery,portal vein, and CBD)

Question 5

T/F: The entire duodenum is retroperitoneal.

Answer 5

False! The first structure is not.

Question 6

Why is a CT scan with oral and IV contrast the most sensitive and specific study to diagnose injuries to hte retroperitoneal duodenum (sections 2-4)?

Answer 6

Findings on PE and DPL are generally negative because of its retroperitoneal location

Question 7

Following trauma, a coiled-spring or stacked-coin appearance of the duodenum is diagnostic of

Answer 7

duodenal hematoma

Question 8

A widening of the duodenal C-loop might suggest

Answer 8

contusion of the head of the pancreas

Question 9

In a urethral injury, urine does not extend down the thigh because of the fusion of Scarpa’s fascia (part of superficial fascia) with

Answer 9

fascia lata (deep fascia)

Question 10

Patients in shock consequent to pelvic fractures may have their bleeding and mortality reduced with what intervention?

Answer 10

early external fixation of the pelvis

Question 11

What should be done if subcutaneous emphysema or an expanding hematoma is found in zone II neck stab wounds?

Answer 11

surgical exploration

Question 12

Loss of upward gaze is attributable to impairment of which two muscles, potentially?

Answer 12

superior rectus, inferior oblique

Question 13

What kind of facial fracture describes the scenario where the entire face is detached from the cranial base?

Answer 13

Le Fort III fracture

Question 14

What is the diagnosis given to a transverse fracture through the articulation of the maxillary and nasal bones with teh frontal bone, passing BELOW the zygomatic?

Answer 14

Le Fort II

Question 15

Fracture passing through the maxillary and nasal bones and ABOVE the zygomatic causing “elongation of the face” and mobility of the middle third of the face on digital manipulation of the maxilla?

Answer 15

Le Fort III

Question 16

A patient bleeding at a rate more than ___mL/hr whould have an emergency thoracotomy.

Answer 16

> 200 mL/hr

Question 17

A hemothorax that is sufficient to require thoracotomy usually comes from which vessels?

Answer 17

The systemic circulation, particularly the internal thoracic (mammary) and intercostal arteries

Question 18

Tamponade from blunt trauma to the heart is usually attributable to which 2 possibilities?

Answer 18

1) myocardial rupture

2) laceration of the coronary arteries

Question 19

This is a reflex autonomic dystrophy (vasomotor instability, swelling, atrophy of skin) occurring after an injury (usually shoulder) that causes immobilization of the ipsilateral extremity:
How is it treated?

Answer 19

“Shoulder-hand” syndrome (catcher with right symptoms)

Treated with prednisone for 2 weeks then tapered.

Question 20

Which imaging study has the best sensitivity and specificity in diagnosing blunt trauma to the pancreas?

Answer 20

CT scan with oral and IV contrast

ERCP is not as helpful in revealing traumatic pancreatitis without ductal injury

Question 21

What is the first step in restoring cardiac return in a patient in the third trimester who has become hypovolemic?

Answer 21

displace the gravid uterus to the left, off of the vena cava

Question 22

THe injury most often missed by selective nonoperative management of abdominal stab wounds is to the

Answer 22

diaphragm

Question 23

What is the treatment given for a raccoon bite?

Answer 23

A 5-day course of HRV and a single dose of HRIG (not administered jointly in the gluteal area, because that would neutralize antibody titers. When feasible, up to half of the dose of HRIG should be infiltrated into the area around the wound)

Question 24

Incision and suction of a snakebite is only of benefit if accomplished within ___minutes of sustaining the bite.

Answer 24

30 minutes

Question 25

Excision of the bite area of a snake bite is valuable only if performed within __ minutes of sustaining the bite.

Answer 25

60 minutes

Question 26

Injury to zone III of the neck (cabove angle of mandible) require angiography because

Answer 26

difficulty in exposure of internal carotid injuries near the base of the skull

Question 27

The most important concern for patients with a stab wound in zone I is

Answer 27

exsanguinating hemorrhage (bleeding into the pleural cavity and mediastinum can occur)

Question 28

In a stable patient with suspected renal injury, what is the next step?

Answer 28

arteriography (operative intervention if patient is unstable)

Question 29

What is the difference in management between stab wounds to the back that do not penetrate past the paraspinus muscles and those that do?

Answer 29

do not penetrate: can be discharged

do: CT scan with IV, oral, and rectal contrast to rule out retroperitoneal colon injuries

Question 30

A contusion to the area of the small bowel 1 cm requires:

Answer 30

1cm = resection

Question 31

T/F: Anastomosis or wound closure in an abdomen with extensive fecal contamination presents a significant risk of leakage and should not be performed.

Answer 31

True

Question 32

Most hepatic bleeding is (arterial/venous)

Answer 32

venous

Question 33

Why shouldn’t a primary anastomosis be performed for a complete bile duct transection?

Answer 33

invariably lead to bile duct stricture; instead, a duct-to-small bowel anastomosis should be performed

Question 34

Obstruction to the portal outflow causes acute splenic hypervolemia simultaneously with systemic hypovolemia. How is treated?

Answer 34

overtransfusion of blood volume

Question 35

T/F: A distal pancreatectomy should not be performed in distal pancreatic injury in the duct remains intact.

Answer 35

True (an intraoperative pancreaticogram can be performed through the injury site if the duodenum is injured, but it should not be opened if it is normal)

Question 36

An intravcaval shunt generally requires a thoracotomy to gain proximal control so is reserved for what kind of injuries to the vena cava?

Answer 36

retrohepatic

Question 37

Packing of the vena cava should be performed only if

Answer 37

acidemia and/or hypothermia develop, since it is not likely to be effective for a long period

Question 38

Describe the tenderness in plantar fasciitis.

Answer 38

Tenderness is over the medial aspect of the plantar fascia close to the calcaneum

Question 39

Xray of plantar fasciitis may reveal nothing, or…

Answer 39

1) calcaneal spur

2) tear in periosteum

Question 40

Which artery contributes to the superficial palmar arches?

Which to the deep palmar arches?

Answer 40

superficial: ulnar artery
deep: radial artery

Question 41

What is the Thompson test?

Answer 41

Failure of plantar flexion to occur after squeezing the gastrocnemius. Indicates rupture of the Achilles tendon.

Question 42

The ability to elevate a straight leg eliminates what lower extremity injuries?

Answer 42

1) patella dislocation

2) quadriceps tendon ruptures

Question 43

What are the borders of the anatomic snuffbox?

Answer 43

Extensor pollicis longus, extensor pollicis brevis, abductor pollicus longus

Question 44

The wrist extensors muscles have their tendinous origins from what?

Answer 44

the lateral humeral epicondyles (repeated dorsiflexion = lateral epicondylitis = tennis elbow)

Question 45

A skull fracture to the anterior cranial fossa may produce rhinorrhea if there is leakage of CSF through

Answer 45

a fractured cribriform plate

Question 46

Which portions of the colon are retroperitoneal?

Answer 46

ascending and descending (not transverse or sigmoid)

Question 47

What structures are retroperitoneal?

Answer 47

SAD PUCKER
Suprarenal glands (adrenal), Aorta/IVC, Duodenum (2-4 segmetns), Pancreas (but not the tail, which is in the splenorenal ligament), Ureters, Colon (ascending and descending), kidneys, esophagus, rectum

Question 48

What can best rule out possible retroperitoneal injury caused by a stab wound?

Answer 48

CT scan with IV and oral contrast

Question 49

In a patient with significant bleeding, peritoneal contamination, and multiple injuries, how is a splenic laceration treated?

Answer 49

splenectomy (and packing of liver injury)