Trauma and US

Question 1

What is a normal FHR?

Answer 1

120-160

Question 2

Central cord Injury - what mechanism?

What is the resulting injury?

Answer 2

Hyper extension —> Extra Credit

Sensory deficits loss in UE > LE

Question 3

Pt w/signs and symptoms of basilar skull fracture but negative CT, do what? Why?

Answer 3

Emergent Neurosurg consult —> CT is NOT 100% diagnostic

Question 4

Everything distal to what structure defines anterior urethral injury?

What kind of injury?

Answer 4

Urogenital diaphragm

Straddle injury

Question 5

Where do you place the probe 1st for US FAST exam?

Answer 5

RUQ view —> Longitudinal at Anterior axillary line

Question 6

Posterior urethral injury occurs in what setting?

What else can occur with this injury?

Answer 6

Pelvic fracture

Bladder rupture

Question 7

Widened mediastinum on PA/supine is what?

Upright?

Answer 7

8cm

6cm

Question 8

Anterior cord syndrome what mechanism of injury?

Causes what?

Answer 8

Flexion injury —> Free Agent

B/l motor paralysis, loss of pain/temp
2pt tactile and vibration INTACT

Question 9

Where to start the FAST exam in blunt trauma?

Penetrating trauma?

Answer 9

RUQ (Morrison’s pouch)

Cardiac window —> r/o Tamponade

Question 10

Teardrop fracture can happen in what setting?

What structure will be injured?

Answer 10

Diving into a pool

Anterior spinal artery

Question 11

Aortic dissection what findings on CXR?

Answer 11

Widened mediastinum

Obscured aortic knob

Question 12

What is the NEXUS criteria?

Answer 12

CPAIN —> Cervical midline TTP, Pain-distracting, AMS, Intox, Neuro deficit
No midline C spine tenderness
No EtOH
Normal alertness
No FND
No distracting injury

Question 13

Where do you perform the pericardial incision?

Relative to phrenic nerve?

Answer 13

5th ICS

Vertical, parallel, anterior to phrenic n.

Question 14

Bike handlebar injury #1 MC?

Answer 14

Duodenum

Then pancreas

Question 15

What is the MC injury in GSW?

Stab wound?

Answer 15

Small bowel

Lover

Question 16

Diaphragmatic injuries occur MC d/t what?
Occur where?

Symptoms?

Dx how?

Answer 16

Blunt trauma
T4-T10 (nipple - navel)

sob, cp, abd pain

Laparoscopy w/sx repair, No imaging is sensitive enough

Question 17

What are the UNSTABLE C-spine fractures?

Answer 17

Jefferson Bit Off A Hangman’s Tit
Jefferson
B/l facet dislocation
Odontoid (2, 3)
Atlanta-occipital/axial dislocation
Hangman
Teardrop

Question 18

Patient that has b/l facet dislocation had what mechanism of injury?

Answer 18

Hyperflexion

Question 19

What is a Jones fracture?

Answer 19

Fracture w/in 1.5cm of 5th metatarsal tuberosity w/out extension distal to 4th-5th intermetatarsal articulation

Question 20

What is pathognomonic for diaphragmatic injury?

What test to do?

Answer 20

Coiled NG tube in chest

Laparoscopy

Question 21

Pt with a open book pelvic fracture, treat how?

Answer 21

Apply pelvic binder at level of greater trochanter

Question 22

What is a posterior urethral injury?

Answer 22

Proximal to diaphragm, due to Pelvic fractures

All the Ps!!!

Question 23

Describe a Teardrop fracture, where is it?

D/t what kind of injury?

Can cause what syndrome?

Answer 23

C5 wedge shaped fracture at base of vertebral body

Extreme flexion and axial load, MC d/t diving injury

Anterior cord syndrome

Question 24

How is the oculovestibular reflex tested?

With intact cortex and brain stem, what are the results?

Answer 24

Irrigate ear canal w/cold water

Nystagmus away from irrigated ear, slow part towards ear

COWS - cold opposite, warm same

Question 25

When is Nimodipine contraindicated in SAH?

Answer 25

When the SAH is d/t trauma Given in spontaneous SAH to prevent vasospasm

Question 26

What delta pressure indicates compartment syndrome?

Answer 26

< 30

Question 27

What is the management of a Jones fracture?

Answer 27

Non weight bearing LL cast/splint for 6-8 weeks w/ortho fu

Question 28

What mandibular fracture is the only kind that does NOT require Abx? Why?

Answer 28

Condylar It is the only one that is CLOSED

Question 29

What muscles does the median nerve control?

Answer 29

Meat LOAF | Lumbricals in digits 1+2, Opponens pollicis, Abductor pollicis breves, Flexor pollicis brevis

Question 30

Pt with Brain injury and they give you Vitals look for WHAT?!!??!

Answer 30

Cushing Reflex - HTN, bradycardia, irregular respirations

Question 31

Pt w/foreign body in eye that gets a corneal rust ring, what is next step in management?

Answer 31

CT orbit

Question 32

DVT US study always performed how? With what probe?

Answer 32

Transverse plane, Linear probe or Curvelinear in fat people

Question 33

The common femoral vein divides into what? What can occur?

Answer 33

Superficial and deep femoral vein Duplication of venous system (1/3 of pts)

Question 34

How do you decipher a pericardial effusion from pleural effusion on US?

Answer 34

Pleural effusion will not extend past the descending aorta on PSLX Pericardial effusion will EXTEND anterior to the descending aorta

Question 35

What are the 2 main landmarks in the perihepatic window? What else?

Answer 35

Glisson’s capsule of liver and Gerota’s fascia Perinephric fat

Question 36

What is the earliest finding of IUP? Seen when? Embryo seen when?

Answer 36

Yolk sac 5-6 weeks 6+ weeks

Question 37

When is cardiac activity seen in relation to CRL?

Answer 37

> 5mm CRL

Question 38

What size makes the diagnosis of AAA? Over 90% of them are what? What size indicates high chance of rupture?

Answer 38

> 3cm Infarenal > 5cm

Question 39

Describe the flow of urine from out of the kidney

Answer 39

medullary pyramids —> minor calyces —> major calyces —> renal pelvis —> ureter —> bladder

Question 40

What is normal optic sheath nerve diameter? If it is elevated, what can it indicate?

Answer 40

< 5 mm Increased ICP

Question 41

How to tell posterior vitreous detachment from retinal detachment?

Answer 41

Turn gain all the way down, PVD will disappear

Question 42

What is McConnell’s sign? What else will you see in the echo with this sign? What view to see?

Answer 42

Norm/hypokinesis of apical segment of RV free wall WITH hypo or akinesia of the remaining free wall of the RV Dilated RV Apical 4CH

Question 43

What is the D sign? What view? Indicates what?

Answer 43

LV appears as a “D” due to bowing of RV on the intraventricular septum PSSA PE, pulm HTN, ARDS, basically right heart strain

Question 44

Jefferson fracture is also called what? Seen in what kind of injury? Xray will show what?

Answer 44

C1 burst Axial loading, football spear Lateral masses are misaligned

Question 45

What is a Chance fracture? Occurs where? Need to eval for what else?

Answer 45

Flexion-distraction injury Transverse fx through ant/mid/post columns assoc w/use of a lap belt Bowel injury