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Trauma And Accidents > Trauma And Accidents > Flashcards

Trauma And Accidents Flashcards

1
Q

What is the classical triad of Wernikes Encephalopathy?

A

Confusion
Ataxia
Occulomotor abnormalities

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2
Q

What drug do you give in suspected Wernikes encephalopathy?

A

Pabrinex (thiamine)

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3
Q

What is delirium tremens?

A

Hallucinations in alcohol withdrawal

  • tactile
  • auditory
  • visual
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4
Q

What drug used to treat symptoms of alcohol withdrawal (non encephalpathy)

A

Chlordiazepoxide

Benzodiazepine

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5
Q

At what pressure should CPP be kept at in traumatic brain injury?

A

> 80 mmHg

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6
Q

What type of headache suggests raised ICP?

A

Throbbing

Worse with raised pressure (cough, sneeze, after lying down)

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7
Q

What is Cushings triad for raised ICP?

A

Hypertension (to maintain CPP)
Bradycardia
Irregular respirations

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8
Q

Signs of uncal herniation?

A

Unilateral dilated pupil
Ptosis
Down and out eye

Contralateral Hemiparesis

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9
Q

What’s the classic sign on central herniation?

A

‘Sunset eyes’ Eyes that look down as up ability is lost

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10
Q

What drug would you treat paracetamol OD with

A

Acetylcystine (after taking blood paracetamol level)

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11
Q

What time after ingestion should you take blood paracetamol level after OD?

A

4 hrs (use to assess if acetylcystine is needed)

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12
Q

What is the classic presentation of neck of femur fracture

A

Shortened and externally rotated leg

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13
Q

Give two features typical of a partial thickness (2nd degree) burn

A

Wet

painful

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14
Q

Give two features typical of a full thickness burn

A

Dry

Lack of sensation

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15
Q

Give four signs of basal skull fracture

A

Battles sign
Panda eyes
Bleeding from ears
CSF otorrhea/rhinorea

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16
Q

What drug do you treat spasming blood vessels in subarachnoid heamhorrage with?

A

Nimodipine (calcium channel blocker)

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17
Q

What do cerebral contusions look like on CT?

A

Small white spots

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18
Q

What is a common Hx of diffuse axonal injury?

A

Rapid acceleration or deceleration of the head

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19
Q

Classic finding in diffuse axonal injury?

A

Physical findings disproportionate to a normal looking CT

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20
Q

Give 4 symptoms of subarachnoid heamhorrage

A

Thunderclap headache
Photophobia
Meningism
Focal neuro deficits

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21
Q

Give three risk factors for subdural heamhorrage

A

Old
Alcoholic
On anticoagulant

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22
Q

What level is bicep reflex?

A

C5/6

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23
Q

What level is tricep reflex?

A

C7/8

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24
Q

What level is patellar reflex?

A

L3/4

On aLL 4s

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25
Q

What level is Achilles’ tendon reflex?

A

S1/2

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26
Q

What is classic symptom of central cord syndrome

A

Loss of movement and sensation in arms and hands (cape like distribution)

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27
Q

How do you treat neurogenic shock?

A

Vasopressors

Atropine (anti parasympathetic)

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28
Q

First line management in causes equina syndrome

A

Urgent MRI

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29
Q

What three x ray views should be taken in suspected c spine injury?

A

AP
Lateral
Open mouth peg

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30
Q

What imaging if suspected spinal cord injury?

A

MRI

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31
Q

What imaging if x ray shows bony fragments?

A

CT

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32
Q

Give a vestibular suppressant used in meniere’s

A

Prochlorperazine

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33
Q

How do you differntiate upper and lower facial nerve lesion?

A

Upper - can frown

Lower - can’t frown

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34
Q

Management for facial nerve palsy

A

Prednisolone

Aciclovir (antiviral)

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35
Q

Treatment for angioedema?

A

Antihistamine

Steroids

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36
Q

What is Ludwigs angina (clue - no to do with heart)

A

Rapid progressing Cellulitis of the floor of mouth. Elderly pts. Often precipitated by dental procedures
Risk of airway obstruction

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37
Q

Give three factors to tell bacterial pharyngitis from viral

A

No cough
Nasal congestion
Nasal discharge

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38
Q

Give main symptoms of mumps

A

Parotiditis

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39
Q

What virus infecting parotid gland causes mumps?

A

Paramyxovirus

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40
Q

Give three complications of sinusitis

A

Orbital cellulitis
Potts puffy Tumor (osteomyelitis of frontal bone)
Brain abscess

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41
Q

Three treatments for sinusitis

A

Amoxicillin/doxicillin
Decongestants (oxymetazoline)
Analgesia

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42
Q

What is the mechanism of action of transexamic acid?

A

Plasmin inhibitor (plasmin degrades fibrin)

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43
Q

What is the mainstay of aspirin OD management?

A

Urinary Alkalanisation

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44
Q

What situation do you give sodium bicarbonate in TCA OD?

A

QRS >100ms

Acidosis

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45
Q

How is anterior sternoclavicular joint dislocation managed?

A

Broad arm sling

Fracture clinic

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46
Q

Common cause of sternoclavicular joint dislocation?

A

Direct blow to chest or shoulder

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47
Q

What is common complication of posterior sternoclavicular joint dislocation?

A

Injury to mediastinal structures

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48
Q

Management of post stternoclavicular joint dislocation?

A

CT mandatory

Ortho referral

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49
Q

Give two likely causes of posterior shoulder dislocation

A

Seizure

Electric shock

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50
Q

What is the common presentation of the arm in shoulder dislocation?

A

Abducted, ext rotated, elbow flexed

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51
Q

What two neurovascular structures are common damaged in shoulder dislocation and how do you assess them?

A 
Auxiliary nerve (check skin over  deltoid sensation)
Auxiliary artery (check radial pulse)
52
Q

What is the main presentation of surgical neck of humerous fracture

A

elbow pain

53
Q

what nerve is most commonly injured in humeral shaft fracture?

A

radial

54
Q

what is the most common cause of supracondylar fractures?

A

Blow to post side of flexed elbow

55
Q

What nerve is commonly injured in olecranon fractures

A

ulnar

56
Q

what is a monteggia fracture

A

proximal ulnar fracture with radial head dislocation

57
Q

what is galeazzi fracture

A

distal radius fracture with dislocation of the distal radial-ulnar joint

58
Q

What is the limb presentation in a neck of femur fracture

A

shortened and externally rotated

59
Q

What is the management for garden stage 3 and 4 neck of femur fractures?

A

hemi or total arthroplasty

60
Q

What is the management for garden stage 1 and 2 neck of femur fractures?

A

Internal fixation

61
Q

What differs garden stage 1 and 2 from 3 and 4 neck of femur fractures

A

1 and 2 are undisplaced

62
Q

What is the classic sign of piriformis syndrome?

A

cant sit with wallet in back pocket without causing pain (wallet sign)

63
Q

What splint should be applied to a shaft of femur fracture

A

Donway splint

64
Q

How do you test for a meniscal tear in knee injury?

A

McMurrays test (painful locking when knee extended with a internal or external rotation)

65
Q

Give 5 sitations where x ray in indicated for knee injury (ottawa knee rules)

A 
>55
fibula head tenderness
Can't flex to 90 degrees
Isolated patella tenderness
Cant weight bear (cant take 4 steps)
66
Q

What is the only direction patella can dislocated?

A

laterally

67
Q

What is the mangement for a dislocated patella

A

relocate under nitrosoxide (N2O)

68
Q

How do you test for a patellar fracture that self relocated

A

Apprehension test (push patella medially, causes pain)

69
Q

What is a segond fracture

A

Avulation fracture (soft tissue tears off bone) affecting lateral tibeal plateau

70
Q

What injury is 75% associated with segond fracture

A

ACL disruption

71
Q

Give two mechanisms of injury of segond fracture

A

int rotation

varus force

72
Q

What type of laceration should stitching be avoided

A

pretibeal laceration

73
Q

What is a maisonneuve fracture

A

Proximal Spiral fibula fracture with distal disruption of tibeal-fibula syndesmosis

74
Q

What are the 5 Ps of compartment syndrome

A 
Pain (disproportionate)
Parlysis
Pallor
Paraeasthesia
Pulseless
75
Q

What ligament is most commonly sprained in foot inversion injuries?

A

Talofibular ligament

76
Q

What test is for acheillies tendon rupture

A

Simmonds test (lie prone, squeeze tendon, no plantar flexion if ruptured)

77
Q

What is the most common metatarsal fracture?

A

Base of the 5th

78
Q

What is the difference between a jones and a psudojones fracture

A 
jones = transverse fracture at base of 5th metatarsal involving joint ot 4th metatarsal
Psudojones = Avulsion fracture
79
Q

What is a lisfrank fracture?

A

Displacement of one or more metatarsals from the tarsus

80
Q

What would you see on a xray of an impacted neck of femur fracture?

A

increased opacity at the area of overlap

81
Q

What is osteitis pubis?

A

Ideopathic inflammation of pubic symphysis and surround structures. Caused by repetive truma around area (surgury or atheltes)

82
Q

How do you exclude a quads tendon tear in knee soft tissue injury?

A

Supine leg raise

83
Q

What are the three sources of bleeding into the knee?

A

Hemarthrosis
Cruciates
Meniscus

84
Q

What are the Ottawa ankle rules for foot Xray

A

Malleolar/midfoot pain+

Bony tenderness on either malleolus/navicualr bone/ 5th metatarsal OR cant weight bear immediately and in A and E

85
Q

What is Bohlers angle?

A

Between ant and post aspects of sup side of calcaneus. >20 degrees suggests a fracture

86
Q

What is the MOI of skiers thumb?

A

Fall on outstretched thumb

87
Q

What bone is most likey to break when punching an wall?

A

neck of 5th metacarpal (boxer’s fracture)

88
Q

How would you diagnose CO poisoning from smoke inhalation and how would you treat?

A

Raised blood COHb

Give 100% O2 to restore oxygen sats

89
Q

What formula is used to assess fluid requirements for burns?

A

Parkland formula (4ml/kg/% burns then adjust for time after injury)

90
Q

What fluid d oyou give for resus in burns?

A

Warmed Hartmans

91
Q

What is the advantage of giving lignocaine (lidocaine) w epinephrine in wound management?

A

Causes vasoconstriction so reduces bleeding

92
Q

Which has a slower onset but longer duration out of Lidocaine or Bupivacaine?

A

Bupivacaine

93
Q

Give an indication for using hydrogen peroxide to clean wounds?

A

To elevate a forign body

94
Q

Give 2 risks of using hydrogen peroxide to clean a wound

A 
Surgical emphysema (air under skin)
O2 emboli
95
Q

Give two cleaning agents that can be used to clean contaminated wounds? (and their cons)

A

Betadine (slows healing , may be toxic)

chlorhexadine (slows healing)

96
Q

Give three contraindications forusing steristrips

A

Irregular wound
Oily/hairy surfaces eg. scalp
Skin over major joints

97
Q

give three indications to use steristripps

A

superfiscial straight lacerations under little tension
Flaps (that suture could compromise the blood supply of)
Elderly patient or Steroid dependant

98
Q

Give four signs that may suggest an inhalation injury in a burns patients

A

Sooty sputum
Respiratory distress
Voice change
Deep facial burns

99
Q

Which thickness of burns needs a referal?

A

Deep partial thickness and higher

100
Q

Give 5 signs of burns sepsis syndrome/ toxic shock syndrome

A 
>38 degrees
Rash
D + V
Malaise
Not eating
101
Q

Give 5 situations where acetylcystein may be started without a blood test in paracetamol OD

A 
Unconcious
Pt jaundiced or hepatic tenderness
uncertainty of timing of dose
presents >8hrs after dose
staggered OD
102
Q

Give 4 signs/symptoms of hepatic necrosis after paracetamol OD

A

R subcostal pain
nausea
jaundice
2-3 days after

103
Q

Give 3 pharmacodynamic features of tricyclic antidepressants that are active in OD

A 
Antimuscarinic (causes tachycardia)
Anti a1 (causes vasodiilation)
Type 1 antiarrythmic (Elongates AP/QRS complex)
104
Q

Give 6 features of Tricyclic antidepressant OD

A 
tachycardia
hypotension
flushed hot skin
dry mouth
urinary retention
Dilated pupils
105
Q

For what 2 reasons may you give sodium bicarbonate in tricyclic antidepressant poisoning

A

To narrow QRS from >100ms to <100ms

If severely acidotic

106
Q

Give three management options for cocaine OD (exept supportive)

A

Benzos for agitation
labetalol
nitropruside (vasodilator for malignant HTN)

107
Q

Give 5 features of fetal alcohol syndrome

A 
Small head
Heart defect
Small eyes (abnormal face)
Mental impairment
Absent Philthrum (cleft on upper lip)
108
Q

Give one condition other than fetal alcohol syndrome that consumption in pregnancy can cause

A

Alcohol Related Neurodevelopmental disorder

109
Q

Give three features of korsakoffs amnesia

A

Loss of memory of recent events
Confabulations (kippers!)
Confusion

110
Q

Give three drugs that can be used to manage alcohol dependancy

A

Acamprosate calcium (camprol)
Disulfiram (Antabuse)
Nalmefene (Selincro)

111
Q

How does Nalmefene work for alchol dependance and give 1 Sx

A

Reduced urge to drink

Blocks opioid receptors so morphiine wont work!

112
Q

How does Disulfiram work for alcohol dependancy?

A

Produced horrible symptoms if patient drinks

113
Q

How does Acamprosate Calcium work for alcohol dependancy?

A

Reduces craving. For Pt who have acheived abstinence

114
Q

In what injury may autonomic dysreflexia occur?

A

Spinal cord lesion above T6

115
Q

Give 3 signs/symptoms of autonomic dysreflexia

A

Extreame HTN
Diaphoresis (sweating) above lesion
Agitation

116
Q

What serious consequence is autonomic dysreflexia at risk of causing

A

Heamhorragic stroke due to extream HTN

117
Q

describe the HINTS test for assessing if vertigo is central or periferal

A

Head Impulse - head thrust test to see if vestibulooccular reflex is impaired. If so, suggests its periferal (slower saccades used)
Nystagmus - look for vestibular nystagmus (periferal)
Test of Skew - Get Pt to look at your nose. Cover and uncover one eye at a time - if they have to correct when uncovered, suggests central cause

118
Q

What age groups are more likely to get anterior (Kisselbachs plexus) and posterior epitaxis respectively?

A

Anterior (children and young people)

Posterior (elderly)

119
Q

what part of the clavical is most likely to break?

A

middle 1/3

120
Q

What is the hippocratic method to relocate a dislocated shoulder?

A

Foot on chest or armpit

gentle traction and external rotation

121
Q

What is stimpsons method for relocating a shoulder?

A

lie pt supine

hang a 2-10 kg weight from wrist

122
Q

Give the 4 steps is Kochers method for shoulder relocation

A

traction
external rotation
adduction
medial rotation

123
Q

What nerve is most likely to be damaged in humeral shaft fracture and what is the symptoms

A

radial

wrist drop

124
Q

What 2 structures are likely to be damaged in olecranon fractures?

A

Ulnar nerve

triceps tendon

125
Q

What is the management for Garden 1 and 2 fractures of the neck of femur (undisplaced)

A

internal fixation

Trauma And Accidents (1 decks)

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