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MCCQE1 > Trauma and emergency > Flashcards

Trauma and emergency Flashcards

1
Q

Signs og basical skull fracture

A
  • Raccoon eyes
  • Battle sign (hematoma behind the ear)
  • Clear otorrhea
  • Clear rhinorrhea

Next step: CT scan of head and neck

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2
Q

Patient with righ head trauma who then presents LOC, followed by a lucid interval and then coma. On exam presents right fixed dilated pupil and left hemiparesis.

Dx, Next step, tx?

A

Epidural hematoma + herniation syndrome

Next step: CT scan will show a lens shaped hematoma

Tx: craniotomy

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3
Q

Adolescent who had a massive head trauma and then LOC with no licid period.

Dx, Next step, tx?

A

Acute subdural hematoma

Next step: CT scan showing a crescent shaped hematoma

Tx: ↓ intracranial pressure (ICP)

  • Hyperventilate once intubated
  • Elevate head of bed
  • Manitol
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4
Q

Old patient who 6 months ago fell from his bed. His daughter says that his is having more headaches ever since and she has notice a decreased cognitive function.

Dx, next step, tx?

A

Chronic subdural hematoma

Dx: CT scan showing a crescent shaped hematoma

Tx:

  • Craniotomy
  • Anticoagulation adjustment if needed
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5
Q

Patient who was playing football and had head trauma, followed by LOC. He is now lucid bud doesn’t remember the event.

CT is normal

Dx?

A

Concussion

Close observation at home with alarm signs

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6
Q

Patient who in a car accident had angular trauma (the car spun). Since the accident is is in coma.

CT scan showing grey/white blurring

A

Diffuse axonal injury

Tx: Really poor prognosis, basically manage the ICP

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7
Q

ABCs, patient presentation when airway is patent

A

o Speaks full sentences
o No use of accessory muscles
o Bilateral breath sounds

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8
Q

ABCs, patient presentation when airway is urgent or emergent

A

Urgent airway (may need to be intubated):
o Expanding hematoma
o Cutaneous emphysema

Emergent airway:
o Apnea
o GCS < 8
o Gurgling/gasping

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9
Q

Parameters that manage problems with ventilation

A

Ventilation (CO2)
• Assessed with ABG = pCO2
• Managed with Minute ventilation = Tidal volume x RR

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10
Q

ABCs (breathing)

Parameters that manage problems with oxygenation

A

Oxygenation (O2)
• Assessed with SatO2 / pO2
• Managed with PEEP, FiO2

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11
Q

Patient presentation of someone with shock

A
  • Syst BP < 90 / (MAP < 65)
  • Urinary output < 0.5 cc/kg/hr
  • Pale, cool, diaphoretic, sense of impending doom
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12
Q

Patient in shock (hypotension) and warm extremities. Differentials?

A

Problems in systemic vascular resistance, e.g.,

  • Sepsis
  • Anaphylaxis
  • Anesthesia
  • Spinal trauma
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13
Q

Patient with Flat neck veins, Normal lungs, ↑HR, Hypotension, Cold extremities.

Dx, next step, tx?

A

Hemorrhage

Next step: FAST (U/S)

Tx: pressure, surgery
- Large bore IV, type and cross, IVF, transfusion on their way to the OR

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14
Q

JVD, ↓ breath sounds, hyperresonance, Traqueal deviation, Hypotension, Cold extremities.

Dx, next steps?

A

Tension pneumo

Next steps:

  • Needle decompression, i.e., thoracostomy (not a chest tube) with a 14G needel in the 2nd costal space
  • Then, get the CxR and put the chest tube
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15
Q 
Patient with: 
•	JVD
•	Distant heart sound
•	Hypotension
•	Paradoxal pulse (↓Systolic BP during inspiration > 10 mmHg)
•	Cold extremities
•	Normal lung sounds

Dx, next steps, tx?

A

Pericardial tamponade

Next step: Pericardiocentesis guided by U/S (FAST)

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16
Q

Beck’s triad?

A
  • JVD
  • Distant heart sound
  • Hypotension
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17
Q

Definition of paradoxal pulse

A

↓ pulse amplitud and ↓Systolic BP of > 10 mmHg during inspiration

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18
Q

Patient who was bitten by a raccoon.

Tx?

A

Capture the animal, kill it and Bx the brain to see if there is rabies. If rabies, give immunoglobulin and vaccine

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19
Q

Patient who was stung by a wasp and now is hypotensive and has bronchospasm.

Tx?

A
  • IM epinephrine 1:1,000

* H1 + steroids (alternative)

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20
Q

Patient who was bitten by a snake.

How to know if he need the anti-venom?

A

Snake Likely poisonous if

  • Slit-like eyes
  • Cobra cowl
  • Rattler

Patient risk fx:

  • Skin changes
  • Erythema
  • Pain out of proportion
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21
Q

Patient who was bitten by a spider with hourglass on the belly. The patient refers abdominal pain.

Dx? What do you have to keep an eye on?

A

Black widow bite

Calcium levels. Give IV calcium

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22
Q

Patient who was in florida and was bitten by spider in a attic. He had initially a bite, but now it is a necrotic ulcer.

What type of spider and tx?

A

Brown recluse

Tx: debride–> grafting

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23
Q

Patient who was bitten by his domestic dog.

Microorganism? Tx?

A

Pasteurella

Tx:

  • Irrigation
  • Leave the wound open (heal by secondary intention)
  • Amoxicillin/clavulanate
  • Tetanus Ig + toxoid if > 5 years since immunization
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24
Q

Management of human bites?

A

Tx (same as dog/cat bite):

  • Irrigation
  • Leave the wound open (heal by secondary intention)
  • Amoxicillin/clavulanate
  • Tetanus Ig + toxoid if > 5 years since immunization
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25
Q

Patient with penetrating neck trauma and unstable (Gurgling, Stridor, Loss of airway, Vascular, Expanding hematoma, Pulsatile bleeding, Stroke, Shock).

Next step?

A

Surgery

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26
Q

Patient with penetrating neck trauma, but stable and otherwise ASx.

Next step?

A

Observe, if worsens perform a CT angio

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27
Q

Patient with penetrating neck trauma and stable. However, presents soft signs (Dysphonia, Dysphagia, Subcutaneous emphysema, hematoma).

Next step?

A

CT angio, if (+)–> surgery. If (-) observe

If proximal third involved, it could be replaced with a arteriogram.

If distal third involved, it could be replaced with esophagram, bronchogram, and arteriogram

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28
Q

Patient with trauma of neck. He has Ipsi lateral proprioception/vibration loss, Ipsi lateral motor loss (Flaccid paralysis and Hyporeflexia at the level with Spastic paralysis and Hyperreflexia bellow the level), and contra lateral pain/temp loss.

Dx?

A

Hemi section

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29
Q

Patient with trauma of neck. No sensory, no motor, no pain/temp on both sides. Flaccid paralysis and Hyporeflexia at the level with Spastic paralysis and Hyperreflexia bellow the level.

Dx?

A

Complete transection

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30
Q

Patient with trauma of neck. Bilateral motor loss, Bilateral pain/temp loss, Proprioception/vibration normal.

Dx?

A

Anterior cord lesion

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31
Q

Patient with Loss of pain/temp in a cape-like distribution during the last months.

Dx?

A

Chronic Central cord lesions (syringomyelia)

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32
Q

Patient with trauma of neck for hyperextension. • Loss of pain/temp and motor in a cape-like distribution

Dx?

A

Central cord lesions

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33
Q

Patient with trauma of neck. Bilateral Proprioception/vibration loss, Normal motor, Normal pain/temp.

Dx?

A

Posterior cord lesion

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34
Q

Patient who tried to kill himself by taking 30 pills of acetaminophen. AST and ALT are > 1,000

Next step, tx?

A

Acetaminophen levels at 4 and 16 hours from ingestion

Tx:

  • N-acetyl cysteine if above lab limits
  • Observe if below
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35
Q

Patient who tried to kill himself by taking 60 pills of aspirin. Tinnitus, N/V, Vertigo, Primary respiratory alkalosis, anion gap acidosis, Hyperpyrexia.

Next step, tx?

A

Next step: Salicylate levels

Tx:

  • Alkalization urine (to trap the acids of salicylates), then
  • Forced diuresis
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36
Q

Patient who was on a fire and has headache, N/V.
SpO2 100%

Dx, next step, tx?

A

Carbon monoxide intoxication

Next step:

  • ABG
  • Carboxy hemoglobin

Tx: Increase wear off of CO

  • 100% FiO2
  • Hyperbaric
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37
Q

Patient who was on a fire, in a poor state with chery-red skin.

Dx, tx?

A

Cyanide intoxication

Tx: Thiosulfate

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38
Q

Farmer who has Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis, Bronchoconstriction.

Dx, tx?

A

Organophosphate toxicity

Tx: Atropine and pralidoxime

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39
Q

Patient who is drunk with either alcoholic beverage or robbing alcohol.

Tx?

A

IVF, protect airway

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40
Q

Patient who drank antifreeze.

Type of alcohol and tx?

A

Ethylene glycol

Tx:
Fomepizole (inhibit conversion of toxic metabolites) or EtOH

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41
Q

Patient who drank moonshine and went blind.

Type of alcohol and tx?

A

Methanol

Tx:
Fomepizole (inhibit conversion of toxic metabolites) or EtOH

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42
Q

Patient with blunt chest trauma, who has chest pain, and decrease res movements.

CxR shows one rb fractured.

Tx?

A

Pain control

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43
Q

Patient who had penetrating chest trauma. Dyspnea, Hyperresonance, ↓ breath sounds, ↓ fremitus.

CxR: vertical shadow

Dx, tx?

A

Pneumothorax

Tx: Thoracostomy

44
Q

Patient who had penetrating chest trauma. Dyspnea, Dullness on percussion, ↓ breath sounds, ↓ fremitus.

CxR showing horizontal shadow; air-fluid level

Dx, tx?

A

Hemothorax

Tx: Thoracostomy

45
Q

When to operate an hemothorax?

A

> 20 cc/kg upon tube placement or > 3 cc/kg/h drainage

46
Q

Patient who had chest trauma, and has a sucking chest wound. Tx?

A

Occlusive dressing (taped on 3 sides) + chest tube

47
Q

Definition of flail chest and tx?

A

2 or more ribs fracture in 2 or more places

Tx:
Blinders and weights
If binders fail–> surgery

F/U: consider also pulmonary contusion, myocardial contusion, traumatic dissection of aorta

48
Q

Patient who had blunt chest trauma.
Nomal CxR on day 1 but lung is white out lung on CxR on 2nd day.

Dx and tx?

A

Pulmonary contusion

Tx:

  • Avoid crystalloids
  • Use calloids (coloides)
  • PEEP
  • Diuresis
49
Q

Patient who had blunt chest trauma who has high troponins and changes on the EKG.

Dx, tx?

A

Myocardial contusion

Tx: MONABASH + Diuretics for CHF +/- antiarrhythmic

F/U: FAST to look for pericardial tamponade

50
Q

Patient who had blunt chest trauma who has discordant BP between right and left sides and a wide mediastinum on the CxR.

Dx, next step, tx?

A

Traumatic dissection of the aorta

Next step: CT angiogram or TEE or MRI

Tx: emergent surgery
- ↓ BP with betablockers

51
Q

Patient who was shot under T4 level.

Tx?

A

Exploratory laparoscopy

52
Q

Patient who had a penetrating abdominal trauma with a knife. He has peritoneal signs and evisceration.

Tx?

A

Exploratory laparoscopy

53
Q

Patient who had a penetrating abdominal trauma with a knife. He has no peritoneal signs or evisceration.

Tx?

A

Probe the lesion to see if it’s penetrating.

54
Q

Patient with blunt abdominal trauma. Negative FAST, negative CT scan, but you still have a high suspicion of internal hemorrhage.

Next step?

A

diagnostic peritoneal lavage

55
Q

Tx of rupured live?

A

Exploratory laparoscopy

  • Pringle maneuver during sx (compress the hepatoduodenal ligament, hepatic artery and porta)
  • Sx repair vs lobectomy
56
Q

Patient with blunt abdominal trauma which cause a ruptured spleen. The patient underwent splenectomy.

Next step?

A

Vaccinate against encapsulated organism (e.g., strep and Neisseria)

57
Q

Patient with blunt abdominal trauma whose CT scan shows diaphragmatic hernia.

Dx, tx?

A

Diaphragm rupture

Exploratory laparoscopy

58
Q

Patient with blunt abdominal trauma whose CT scan shows free air at the top of the scan. The KUB shows air under diaphragm.

Dx, tx?

A

Ruptured hollow viscus

Exploratory laparoscopy

59
Q

Patient who was in a car accident. He has pain during the hip-rock maneuver.

Dx, next step, tx?

A

Pelvic fracture

Next step: CT scan and retrograde urethrogram

Tx: external fixation might be sufficient
- If blood goes into the peritoneum then surgery, otherwise generally not needed

F/U: urethral trauma, rectal injury

60
Q

Patient who was in a car accident, who has a pelvic fracture. On digital rectal exam you identify a High-riding prostate. You also see Blood at the meatus.

Dx, next step, tx?

A

Urethral trauma

Next step: retrograde urethrogram

Tx: suprapubic cath

61
Q

Patient who was in a car accident in whom you suspect rectal injury and ureter injury.

Next steps?

A

Proctoscope and intravenous pyelogram

62
Q

Patient with a chemical burn.

Tx?

A
  • Irrigate and irrigate and irrigate and irrigate

* NEVER buffer (because it created heat and burns more)

63
Q

Patient who ingested and acid or alkali

Tx?

A
  • Observation, series of CxR and call IG for an EGD
  • NEVER induce emesis
  • NEVER NG tube
  • NEVER buffer
64
Q

Patient who was on a fire and has  Soot/singed nares and stridor.
Next steps?

A
  • ABG, SPO2, peak-flow
  • Bronchoscopy
  • Close monitor
  • If deterioration –> prophylactic intubation
65
Q

Patient who was stricken by a lightning.

Next steps, tx?

A

CK, creatinine to rule out radbomiolisis
And monitor for arrhythmias

Tx: IVF, mannitol to treat rabdo

66
Q

Patient with circumferential burn.

Tx?

A

Cut the eschar and refer

67
Q

Rule of 9s to determine % of body surface?

A 
Head= 9%
Front chest= 9%
Back of chest= 9%
Front abdomen= 9%
Back of adbomen= 9%
Entire arm= 9%
Front of leg= 9%
Back of leg= 9%
Genitalia= 1%
68
Q

Parkland formuka

A

(%BSA burned with 2nd and 3rd degree x kg x 4cc) of LR

Give 50 % in 8 hrs
Give 50% in the next 16 hrs

69
Q

Tx of burns

A 
o	IVF
o	Early movement
o	Early graft
o	Pain control
o	Infection prophylaxis: Topical mupirocin or silver sulfadiazine
70
Q

When to refer a burned patient

A 
o	Face
o	Hands
o	Genitals
o	Circumferential
o	More than 10%
71
Q

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.

A

Antipsychotics (neuroleptic malignant syndrome).

72
Q

Side effects of corticosteroids.

A

Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies.

73
Q

Treatment for DTs.

A

Benzodiazepines.

74
Q

Treatment for acetaminophen overdose.

A

N-acetylcysteine.

75
Q

Treatment for opioid overdose.

A

Naloxone.

76
Q

Treatment for benzodiazepine overdose. .

A

Flumazenil

77
Q

Treatment for neuroleptic malignant syndrome and malignant hyperthermia.

A

Dantrolene.

78
Q

Treatment for malignant hypertension.

A

Nitroprusside.

79
Q

Treatment of atrial fibrillation.

A

Rate control, rhythm conversion, and anticoagulation.

80
Q

Treatment of supraventricular tachycardia.

A

If stable, rate control with carotid massage or other vagal stimulation; if unsuccessful, consider adenosine.

81
Q

Causes of drug-induced SLE.

A

INH, penicillamine, hydralazine, procainamide,

chlorpromazine, methyldopa, quinidine.

82
Q

Macrocytic, megaloblastic anemia with neurologic

symptoms.

A

B12 defi ciency.

83
Q

Macrocytic, megaloblastic anemia without neurologic symptoms.

A

Folate deficiency.

84
Q

A burn patient presents with cherry-red fl ushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?

A

Treat CO poisoning with 100% O2 or with hyperbaric O2 if poisoning is severe or the patient is pregnant.

85
Q

Blood in the urethral meatus or high-riding prostate.

A

Bladder rupture or urethral injury.

86
Q

Test to rule out urethral injury.

A

Retrograde cystourethrogram.

87
Q

Radiographic evidence of aortic disruption or dissection.

A

Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus.

88
Q

Radiographic indications for surgery in patients with acute abdomen.

A

Free air under the diaphragm, extravasation of contrast, severe bowel distention, space-occupying lesion (CT), mesenteric occlusion (angiography).

89
Q

The most common organism in burn-related infections.

A

Pseudomonas.

90
Q

Method of calculating fluid repletion in burn patients.

A

Parkland formula.

91
Q

Acceptable urine output in a trauma patient.

A

50 cc/hr.

92
Q

Acceptable urine output in a stable patient.

A

30 cc/hr.

93
Q

Cannon “a” waves.

A

Third-degree heart block.

94
Q

Signs of neurogenic shock.

A

Hypotension and bradycardia.

95
Q

Signs of ↑ ICP (Cushing’s triad).

A

Hypertension, bradycardia, and abnormal respirations

96
Q

↓ Cardiac output (CO), ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).

A

Hypovolemic shock.

97
Q

↓ Cardiac output (CO), ↑ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).

A

Cardiogenic (or obstructive) shock.

98
Q

↑ Cardiac output (CO), ↓ Pulmonary capillary wedge pressure (PCWP), ↓ peripheral vascular resistance (PVR).

A

Septic or anaphylactic shock.

99
Q

Treatment of septic shock.

A

Fluids and antibiotics.

100
Q

Treatment of cardiogenic shock.

A

Identify cause; pressors (e.g., dopamine).

101
Q

Treatment of hypovolemic shock.

A

Identify cause; fl uid and blood repletion.

102
Q

Treatment of anaphylactic shock.

A

Diphenhydramine or epinephrine 1:1000.

103
Q

Supportive treatment for ARDS.

A

Continuous positive airway pressure.

104
Q

Signs of air embolism.

A

A patient with chest trauma who was previously stable suddenly dies.

105
Q

Trauma series.

A

AP chest, AP/lateral C-spine, AP pelvis.

MCCQE1 (19 decks)

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