Trauma And Accidents Flashcards
1
Q
What is the classical triad of Wernikes Encephalopathy?
A
Confusion
Ataxia
Occulomotor abnormalities
2
Q
What drug do you give in suspected Wernikes encephalopathy?
A
Pabrinex (thiamine)
3
Q
What is delirium tremens?
A
Hallucinations in alcohol withdrawal
- tactile
- auditory
- visual
4
Q
What drug used to treat symptoms of alcohol withdrawal (non encephalpathy)
A
Chlordiazepoxide
Benzodiazepine
5
Q
At what pressure should CPP be kept at in traumatic brain injury?
A
> 80 mmHg
6
Q
What type of headache suggests raised ICP?
A
Throbbing
Worse with raised pressure (cough, sneeze, after lying down)
7
Q
What is Cushings triad for raised ICP?
A
Hypertension (to maintain CPP)
Bradycardia
Irregular respirations
8
Q
Signs of uncal herniation?
A
Unilateral dilated pupil
Ptosis
Down and out eye
Contralateral Hemiparesis
9
Q
What’s the classic sign on central herniation?
A
‘Sunset eyes’ Eyes that look down as up ability is lost
10
Q
What drug would you treat paracetamol OD with
A
Acetylcystine (after taking blood paracetamol level)
11
Q
What time after ingestion should you take blood paracetamol level after OD?
A
4 hrs (use to assess if acetylcystine is needed)
12
Q
What is the classic presentation of neck of femur fracture
A
Shortened and externally rotated leg
13
Q
Give two features typical of a partial thickness (2nd degree) burn
A
Wet
painful
14
Q
Give two features typical of a full thickness burn
A
Dry
Lack of sensation
15
Q
Give four signs of basal skull fracture
A
Battles sign
Panda eyes
Bleeding from ears
CSF otorrhea/rhinorea
16
Q
What drug do you treat spasming blood vessels in subarachnoid heamhorrage with?
A
Nimodipine (calcium channel blocker)
17
Q
What do cerebral contusions look like on CT?
A
Small white spots
18
Q
What is a common Hx of diffuse axonal injury?
A
Rapid acceleration or deceleration of the head
19
Q
Classic finding in diffuse axonal injury?
A
Physical findings disproportionate to a normal looking CT
20
Q
Give 4 symptoms of subarachnoid heamhorrage
A
Thunderclap headache
Photophobia
Meningism
Focal neuro deficits
21
Q
Give three risk factors for subdural heamhorrage
A
Old
Alcoholic
On anticoagulant
22
Q
What level is bicep reflex?
A
C5/6
23
Q
What level is tricep reflex?
A
C7/8
24
Q
What level is patellar reflex?
A
L3/4
On aLL 4s
25
What level is Achilles’ tendon reflex?
S1/2
26
What is classic symptom of central cord syndrome
Loss of movement and sensation in arms and hands (cape like distribution)
27
How do you treat neurogenic shock?
Vasopressors
| Atropine (anti parasympathetic)
28
First line management in causes equina syndrome
Urgent MRI
29
What three x ray views should be taken in suspected c spine injury?
AP
Lateral
Open mouth peg
30
What imaging if suspected spinal cord injury?
MRI
31
What imaging if x ray shows bony fragments?
CT
32
Give a vestibular suppressant used in meniere’s
Prochlorperazine
33
How do you differntiate upper and lower facial nerve lesion?
Upper - can frown
| Lower - can’t frown
34
Management for facial nerve palsy
Prednisolone
| Aciclovir (antiviral)
35
Treatment for angioedema?
Antihistamine
| Steroids
36
What is Ludwigs angina (clue - no to do with heart)
Rapid progressing Cellulitis of the floor of mouth. Elderly pts. Often precipitated by dental procedures
Risk of airway obstruction
37
Give three factors to tell bacterial pharyngitis from viral
No cough
Nasal congestion
Nasal discharge
38
Give main symptoms of mumps
Parotiditis
39
What virus infecting parotid gland causes mumps?
Paramyxovirus
40
Give three complications of sinusitis
Orbital cellulitis
Potts puffy Tumor (osteomyelitis of frontal bone)
Brain abscess
41
Three treatments for sinusitis
Amoxicillin/doxicillin
Decongestants (oxymetazoline)
Analgesia
42
What is the mechanism of action of transexamic acid?
Plasmin inhibitor (plasmin degrades fibrin)
43
What is the mainstay of aspirin OD management?
Urinary Alkalanisation
44
What situation do you give sodium bicarbonate in TCA OD?
QRS >100ms
| Acidosis
45
How is anterior sternoclavicular joint dislocation managed?
Broad arm sling
| Fracture clinic
46
Common cause of sternoclavicular joint dislocation?
Direct blow to chest or shoulder
47
What is common complication of posterior sternoclavicular joint dislocation?
Injury to mediastinal structures
48
Management of post stternoclavicular joint dislocation?
CT mandatory
| Ortho referral
49
Give two likely causes of posterior shoulder dislocation
Seizure
| Electric shock
50
What is the common presentation of the arm in shoulder dislocation?
Abducted, ext rotated, elbow flexed
51
What two neurovascular structures are common damaged in shoulder dislocation and how do you assess them?
```
Auxiliary nerve (check skin over deltoid sensation)
Auxiliary artery (check radial pulse)
```
52
What is the main presentation of surgical neck of humerous fracture
elbow pain
53
what nerve is most commonly injured in humeral shaft fracture?
radial
54
what is the most common cause of supracondylar fractures?
Blow to post side of flexed elbow
55
What nerve is commonly injured in olecranon fractures
ulnar
56
what is a monteggia fracture
proximal ulnar fracture with radial head dislocation
57
what is galeazzi fracture
distal radius fracture with dislocation of the distal radial-ulnar joint
58
What is the limb presentation in a neck of femur fracture
shortened and externally rotated
59
What is the management for garden stage 3 and 4 neck of femur fractures?
hemi or total arthroplasty
60
What is the management for garden stage 1 and 2 neck of femur fractures?
Internal fixation
61
What differs garden stage 1 and 2 from 3 and 4 neck of femur fractures
1 and 2 are undisplaced
62
What is the classic sign of piriformis syndrome?
cant sit with wallet in back pocket without causing pain (wallet sign)
63
What splint should be applied to a shaft of femur fracture
Donway splint
64
How do you test for a meniscal tear in knee injury?
McMurrays test (painful locking when knee extended with a internal or external rotation)
65
Give 5 sitations where x ray in indicated for knee injury (ottawa knee rules)
```
>55
fibula head tenderness
Can't flex to 90 degrees
Isolated patella tenderness
Cant weight bear (cant take 4 steps)
```
66
What is the only direction patella can dislocated?
laterally
67
What is the mangement for a dislocated patella
relocate under nitrosoxide (N2O)
68
How do you test for a patellar fracture that self relocated
Apprehension test (push patella medially, causes pain)
69
What is a segond fracture
Avulation fracture (soft tissue tears off bone) affecting lateral tibeal plateau
70
What injury is 75% associated with segond fracture
ACL disruption
71
Give two mechanisms of injury of segond fracture
int rotation
| varus force
72
What type of laceration should stitching be avoided
pretibeal laceration
73
What is a maisonneuve fracture
Proximal Spiral fibula fracture with distal disruption of tibeal-fibula syndesmosis
74
What are the 5 Ps of compartment syndrome
```
Pain (disproportionate)
Parlysis
Pallor
Paraeasthesia
Pulseless
```
75
What ligament is most commonly sprained in foot inversion injuries?
Talofibular ligament
76
What test is for acheillies tendon rupture
Simmonds test (lie prone, squeeze tendon, no plantar flexion if ruptured)
77
What is the most common metatarsal fracture?
Base of the 5th
78
What is the difference between a jones and a psudojones fracture
```
jones = transverse fracture at base of 5th metatarsal involving joint ot 4th metatarsal
Psudojones = Avulsion fracture
```
79
What is a lisfrank fracture?
Displacement of one or more metatarsals from the tarsus
80
What would you see on a xray of an impacted neck of femur fracture?
increased opacity at the area of overlap
81
What is osteitis pubis?
Ideopathic inflammation of pubic symphysis and surround structures. Caused by repetive truma around area (surgury or atheltes)
82
How do you exclude a quads tendon tear in knee soft tissue injury?
Supine leg raise
83
What are the three sources of bleeding into the knee?
Hemarthrosis
Cruciates
Meniscus
84
What are the Ottawa ankle rules for foot Xray
Malleolar/midfoot pain+
| Bony tenderness on either malleolus/navicualr bone/ 5th metatarsal OR cant weight bear immediately and in A and E
85
What is Bohlers angle?
Between ant and post aspects of sup side of calcaneus. >20 degrees suggests a fracture
86
What is the MOI of skiers thumb?
Fall on outstretched thumb
87
What bone is most likey to break when punching an wall?
neck of 5th metacarpal (boxer's fracture)
88
How would you diagnose CO poisoning from smoke inhalation and how would you treat?
Raised blood COHb
| Give 100% O2 to restore oxygen sats
89
What formula is used to assess fluid requirements for burns?
Parkland formula (4ml/kg/% burns then adjust for time after injury)
90
What fluid d oyou give for resus in burns?
Warmed Hartmans
91
What is the advantage of giving lignocaine (lidocaine) w epinephrine in wound management?
Causes vasoconstriction so reduces bleeding
92
Which has a slower onset but longer duration out of Lidocaine or Bupivacaine?
Bupivacaine
93
Give an indication for using hydrogen peroxide to clean wounds?
To elevate a forign body
94
Give 2 risks of using hydrogen peroxide to clean a wound
```
Surgical emphysema (air under skin)
O2 emboli
```
95
Give two cleaning agents that can be used to clean contaminated wounds? (and their cons)
Betadine (slows healing , may be toxic)
| chlorhexadine (slows healing)
96
Give three contraindications forusing steristrips
Irregular wound
Oily/hairy surfaces eg. scalp
Skin over major joints
97
give three indications to use steristripps
superfiscial straight lacerations under little tension
Flaps (that suture could compromise the blood supply of)
Elderly patient or Steroid dependant
98
Give four signs that may suggest an inhalation injury in a burns patients
Sooty sputum
Respiratory distress
Voice change
Deep facial burns
99
Which thickness of burns needs a referal?
Deep partial thickness and higher
100
Give 5 signs of burns sepsis syndrome/ toxic shock syndrome
```
>38 degrees
Rash
D + V
Malaise
Not eating
```
101
Give 5 situations where acetylcystein may be started without a blood test in paracetamol OD
```
Unconcious
Pt jaundiced or hepatic tenderness
uncertainty of timing of dose
presents >8hrs after dose
staggered OD
```
102
Give 4 signs/symptoms of hepatic necrosis after paracetamol OD
R subcostal pain
nausea
jaundice
2-3 days after
103
Give 3 pharmacodynamic features of tricyclic antidepressants that are active in OD
```
Antimuscarinic (causes tachycardia)
Anti a1 (causes vasodiilation)
Type 1 antiarrythmic (Elongates AP/QRS complex)
```
104
Give 6 features of Tricyclic antidepressant OD
```
tachycardia
hypotension
flushed hot skin
dry mouth
urinary retention
Dilated pupils
```
105
For what 2 reasons may you give sodium bicarbonate in tricyclic antidepressant poisoning
To narrow QRS from >100ms to <100ms
| If severely acidotic
106
Give three management options for cocaine OD (exept supportive)
Benzos for agitation
labetalol
nitropruside (vasodilator for malignant HTN)
107
Give 5 features of fetal alcohol syndrome
```
Small head
Heart defect
Small eyes (abnormal face)
Mental impairment
Absent Philthrum (cleft on upper lip)
```
108
Give one condition other than fetal alcohol syndrome that consumption in pregnancy can cause
Alcohol Related Neurodevelopmental disorder
109
Give three features of korsakoffs amnesia
Loss of memory of recent events
Confabulations (kippers!)
Confusion
110
Give three drugs that can be used to manage alcohol dependancy
Acamprosate calcium (camprol)
Disulfiram (Antabuse)
Nalmefene (Selincro)
111
How does Nalmefene work for alchol dependance and give 1 Sx
Reduced urge to drink
| Blocks opioid receptors so morphiine wont work!
112
How does Disulfiram work for alcohol dependancy?
Produced horrible symptoms if patient drinks
113
How does Acamprosate Calcium work for alcohol dependancy?
Reduces craving. For Pt who have acheived abstinence
114
In what injury may autonomic dysreflexia occur?
Spinal cord lesion above T6
115
Give 3 signs/symptoms of autonomic dysreflexia
Extreame HTN
Diaphoresis (sweating) above lesion
Agitation
116
What serious consequence is autonomic dysreflexia at risk of causing
Heamhorragic stroke due to extream HTN
117
describe the HINTS test for assessing if vertigo is central or periferal
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
What age groups are more likely to get anterior (Kisselbachs plexus) and posterior epitaxis respectively?
Anterior (children and young people)
| Posterior (elderly)
119
what part of the clavical is most likely to break?
middle 1/3
120
What is the hippocratic method to relocate a dislocated shoulder?
Foot on chest or armpit
| gentle traction and external rotation
121
What is stimpsons method for relocating a shoulder?
lie pt supine
| hang a 2-10 kg weight from wrist
122
Give the 4 steps is Kochers method for shoulder relocation
traction
external rotation
adduction
medial rotation
123
What nerve is most likely to be damaged in humeral shaft fracture and what is the symptoms
radial
| wrist drop
124
What 2 structures are likely to be damaged in olecranon fractures?
Ulnar nerve
| triceps tendon
125
What is the management for Garden 1 and 2 fractures of the neck of femur (undisplaced)
internal fixation
