trauma/acute care

Question 1

Carnett sign

Answer 1

1. patient tenses abdominal wall
2. pain worsens = abdominal wall issue
3. pain lessens = intra-abdominal process

Question 2

Murphy’s sign

Answer 2

pain with palpation of the RUQ during inspiration, indicative of cholecystitis

Question 3

Rovsing’s sign

Answer 3

Pain in RLQ with palpation of LLQ indicative of appendicitis

Question 4

Psoas Sign

Answer 4

RLQ pain with extension of right leg indicative of appendicitis

Question 5

Obturator Sign

Answer 5

RLQ pain on internal rotation of right thigh indicative of appendicitis, diverticulitis, or PID

Question 6

General management of acute abdomen

Answer 6

stabilize, NPO, IVFs, antiemetics, analgesics, surgery consult

Question 7

Whirl wind or bird beak pattern on Abdominal CT

Answer 7

sigmoid volvulus

Question 8

Coffee bean or comma sign on abdominal CT

Answer 8

cecal volvulus

Question 9

what isthe management of stable cecal volvulus without bowel compromise

Answer 9

open detorsion + ileocecal resection

Question 10

what is the management for unstable cecal volvulus without bowel compromise

Answer 10

open detorsion + cecopexy

Question 11

What is the management for cecal volvulus with bowel compromise in a stable patient?

Answer 11

resection and anastomosis

Question 12

What is the management for cecal volvulus with bowel compromise in an unstable patient?

Answer 12

resection with ileostomy

Question 13

Intussusception presentation

Answer 13

recurring paroxysms of abdominal pain, screaming, knees to chest
currant jelly stool
sausage shaped mass on R side

Question 14

Intussusception diagnosis

Answer 14

US: bullseye lesion
Barium enema: coiled spring

Question 15

treatment of intussusception

Answer 15

barium or air enema

Question 16

what is the treatment of toxic megacolon

Answer 16

Bowel rest, NG suction, abx
+/- corticosteroids
Surgery (colectomy with ileocecal anastomosis)

Question 17

location that differentiates upper from lower GI bleed

Answer 17

Ligament of Treitz

Question 18

GCS Eyes

Answer 18

4 - spontaneous
3 - to voice
2 - to pain
1 - none

Question 19

GCS Verbal

Answer 19

5- oriented
4- confused
3- inappropriate
2- incomprehensible
1- none

Question 20

GCS Motor

Answer 20

6 - Obeys commands
5 - Purposeful movement to pain
4 - Withdraws from pain
3 - Decorticate
2 - Decerebrate
1 - None

Question 21

interpretation of GCS score

Answer 21

15: normal
13-14: mild TBI
9-12: moderate TBI
<8: severe TBI, likely coma.

Question 22

presentation of persistent vegetative state

Answer 22

spontaneous eye opening, sleep-wake cycle, no comprehension/spoken words/purposeful movement

Question 23

Persistent Vegetative State (PVS)

Answer 23

condition in which a person is alive but unable to communicate or to function independently at even the most basic level

Question 24

what damage causes persistent vegetative state

Answer 24

intact brainstem & autonomic function
severe bilateral hemispheric damage

Question 25

Locked-in syndrome (LIS)

Answer 25

Individual is aware and capable of thinking but is paralyzed and cannot communicate

Question 26

causes of Locked-in syndrome

Answer 26

embolic occlusion of basilar artery, infarction, hemorrhage, demyelination, encephalitis

Question 27

presentation of locked in state

Answer 27

voluntary eye opening, moves vertical, possible decerebrate posturing

Question 28

Brain Death presentation

Answer 28

complete unresponsiveness to speech & painful stimuli abscent brainstem reflexes no respiratory response

Question 29

Diagnostic confirmation of brain death

Answer 29

6 hours with flat EEG 12 hours without EEG + serial exams 24 hours for anoxic brain injury without EEG

Question 30

initial management of altered consciousness

Answer 30

IV access + labs administer fluids (D50W, thiamine, glucose, naloxone) empiric ABX

Question 31

Reflexes to test for brain death

Answer 31

pupillary reaction to light (CNIII) corneal reflex (CN V) Dolls eyes/cold caloric (CN III, IV, VI) gag reflex (CN IX, X) Response to pain Respiratory drive

Question 32

Compound fracture

Answer 32

break in the bone where the bone comes through the skin; open fracture ORTHO EMERGENCY

Question 33

Compound fracture management

Answer 33

irrigation/debridement + sterile dressing NPO, pain meds, IV ABX surgery

Question 34

types of compound fractures

Answer 34

* Grade 1: <1 cm wound * Grade 2: >1 cm wound * Grade 3: most severe, 3 levels

Question 35

types of grade III compound fractures

Answer 35

IIIA: wounds with contaminated soft tissue or high energy fractures IIIB: exposed bone due to soft tissue damange/loss IIIC: need vascular intervention

Question 36

types of shock

Answer 36

Hypovolemic Distributive (MC) Cardiogenic Obstructive

Question 37

cardiogenic shock presentation

Answer 37

- Hypotension (SBP<90) - Signs of diminished perfusion: low urinary output, confusion, cold extremities - Doesn't respond to fluid resuscitation - Systemic vasoconstriction - Elevated JVP - May be evidence of pulmonary edema with respiratory compromise in the setting of left-sided heart failure

Question 38

MCC of cardiogenic shock

Answer 38

MI

Question 39

Septic shock (distributive) presentation

Answer 39

Hypotension, mental confusion, pale cool clammy extremities, SOB, decrease urinary output

Question 40

Neurogenic shock (distributive) presentation

Answer 40

warm, peripherally vasodilated, dry skin, hypotensive, bradycardia

Question 41

hypovolemic shock presentation

Answer 41

hypotension anxiety altered mental state cool, clammy skin rapid and thready pulse thirst fatigue tachypnea oliguria

Question 42

indications for a platelet transfusion

Answer 42

include a platelet count <10K, active bleeding with a platelet count <50K or major planned surgery

Question 43

indications for fresh frozen plasma

Answer 43

-Replacement of factor deficiencies (use specific factor if able) -Reversal of warfarin effect (immediate effect) -Massive blood transfusions -Liver disease

Question 44

Indications for cryoprecipitate

Answer 44

- Has Fibrinogen and Factor 8 - Hemophilia, von Willebrand, DIC