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Surgery > Trauma & Ortho > Flashcards

Trauma & Ortho Flashcards

1
Q

In trauma, victims , life-threatening conditions are identified and corrected during the ________.

A

Primary Survey

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2
Q

First priority of the primary survey in ATLS?

A

Securing the airway

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3
Q

Goal of primary survey?

A

Treat conditions that constitute an immediate threat to life

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4
Q

The most common cause of upper airway obstruction in an unconscious patient is?

A

The tongue falls back into the posterior pharynx

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5
Q

Indications for early airway intervention ( preemptive intubation) in trauma?

A
  1. Penetrating injuries to the neck with an expanding hematoma.
  2. Evidence of chemical or thermal injury to the mouth , nares, or hypopharynx.
  3. Extensive subcutaneous air in the neck complex maxillofacial trauma.
  4. Airway bleeding
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6
Q

Zone inferior to the clavicle and manubrium sterni and encompasses all structures in the thoracic outlet?

A

Zone 1

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7
Q

Which of the following is a characteristic of zone I neck injury?

A

Is notorious for occult hemothorax / great vessel injury.

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8
Q

Indications for exploratory laparotomy in penetrating or blunt abdominal injury!

A
  1. Hemodynamically instability
  2. Peritonitis
  3. Evisceration
  4. Positive DPL
  5. Persistent drop in hct
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9
Q

Positive DPL finding in anterior abdominal stab wound?

A
  1. RBCs >100,000 /ml
  2. WBC >500 /ml
  3. Amylase >19 IU/L
    4.Alkaline phosphatase >2IU/L
  4. Bilirubin level >0.01 mg/dL
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10
Q

Maximum duration of pulse checks according to the ACLS guidelines

A

10 seconds

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11
Q

Required treatment for displaced femoral neck fractures in older adults due to the risk that it will disrupt the blood supply.

A

Prosthetic replacement

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12
Q

Fracture of C2 pedicles

A

Hangman’s fracture

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13
Q

Most common malignancy of the bone?

A

Osteosarcoma

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14
Q

Which peripheral nerve is compressed in a 30yo call center agent with carpal tunnel syndrome?

A

median nerve

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15
Q

Most common malignant presacral tumors?

A

Sacrococcygeal chondroma

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16
Q

Fasciotomy is indicated if?

A
  1. Gradient pressure <30mmHg ( Diastolic P- Compartment P)
  2. Absolute compartment P > 30mmHg
  3. Ischemic periods >6hrs
  4. Combined arterial and venous injuries
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17
Q

Life-threatening traumatic injuries?

A
  1. Cardiac tamponade
  2. Massive hemothorax
  3. Hemoperitoneum
  4. Unstable pelvic fractures
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18
Q

Damage control surgery goals?

A
  1. Limit enteric content spillage
  2. Prevent blood vicious cycle
  3. Control bleeding
  4. Prevent ischemia
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19
Q

Causes of bleeding after massive blood transfusion?

A
  1. Hypothermia
  2. Dilutional coagulopathy
  3. Fibrinolysis or Hypofibrinogenemia
  4. Platelet dysfunction
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20
Q

Commom nerve palsy after hip arthroplasty?

A

Sciatic nerve in over 90% of cases followed by femoral nerve

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21
Q

Complications of exploratory laparotomy?

A
  1. Infection
  2. Atelectasis
  3. Ileus
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22
Q

Causes of stress related hyperglycemia in post-op patients?

A
  1. Glucagon
  2. Epinephrine
  3. Glucocorticoid
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23
Q

Components of Glasgow Coma Scale

A
  1. Eye opening
  2. Verbal response
  3. Motor response
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24
Q

Invasive monitoring of patients fluid status

A

CVP ( Central Venous Pressure) when a large amounts of fluids are administered

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25
Q

Anterior knee pain involving the patella and retinaculum

A

Patellofemoral Pain Syndrome / Runners Knee

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26
Q

Structure kyphosis affecting the lower thoracic and upper lumbar regions?

A
  1. Gibbus deformity
  2. Tuberculous spondylitis / Potts Disease
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27
Q

Characteristics of inhalation injury?

A
  1. Increased metabolic demand
  2. Cause direct mucosal and heat injury to upper airways
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28
Q

Etiology of hematemesis that will require emergency management

A
  1. Esophageal varices
  2. Endoscopy with variceal band ligation should be carried out as soon as possible
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29
Q

Diagnostic modalities for lymphedema

A
  1. Lymphoscintigraphy
  2. Duplex ultrasound
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30
Q

Depth of chest compressions in CPR?

A

5.6cm (2-2.4inch ) deep

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31
Q

Number of rescue breaths per cycle?

A

2 breaths

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32
Q

Number of chest compressions per cycle

A

30 compressions

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33
Q

Number of cycles rescuers should perform for CPR to be effective?

A

5 cycles in 2 mins

34
Q

Indication for laparotomy in penetrating abdominal trauma?

A
  1. Hemodynamic instability
  2. Obvious peritoneal signs
  3. Impaled foreign body
  4. Pneumoperitoneum
  5. Herniated abdominal organs
  6. GSW with evidence of intraperitoneal penetration
  7. Blood in orifices
35
Q

The most commonly injured intra abdominal organ following a blunt abdominal trauma

A

Liver

36
Q

Top 2 most commonly injured intra abdominal organs in blunt abdominal trauma?

A

Liver , Spleen

37
Q

The order of priority in the management of a multiple injured patient is?

A
  1. Chest & Abdomen
  2. Head and Spine
  3. Limb
38
Q

In healthy patients who bleed, how many percent of the blood volume is lost for them to manifest significant changes in the vital signs?

A

30%

39
Q

Which of the following traumatic abdominal injuries necessitates immediate surgical exploration?

A

Eviscerated omentum

40
Q

The following are indication for performing exploratory laparotomy among abdominal trauma patients?

A
  1. Omental evisceration
  2. Hemodynamically unstable
  3. Signs of peritonitis
41
Q

Which of the following findings is consistent with disseminated intravascular coagulopathy?

A
  1. Elevated fibrin split products
  2. Thrombocytopenia
  3. Low fibrinogen level
  4. Prolonged prothrombin time
42
Q

How long should a pulse check lasts?

A

Not more than 10 seconds

43
Q

The most dreaded complication seen in elderly patients with displaced interthrocanteric hip fracture ?

A

Uncontrolled bleeding

44
Q

The most malignancy involving bone?

A

Osteosarcoma

45
Q

A 20yo basketball player tear in his anterior cruciate ligament manifested by pain and swelling is best treated with?

A

Arthroscopic surgery

46
Q

Bilateral fracture of the pars interarticularis involving the C2 spine is called?

A

Hangman’s fracture

47
Q

Treatment of choice for non-aligned femoral neck fracture is?

A

Total hip replacement

48
Q

A fracture of the distal radius in which the distal fragment is dorsally displaced is?

A

Colle’s fracture

49
Q

Inappropriate airway maneuver in managing a trauma patient with cervical spinal control ?

A

Head tilt

50
Q

Most common indication for endotracheal intubation?

A

Altered mental status

51
Q

Thoracostomy location in adults?

A

4th ICS or 5th ICS AAL

52
Q

Definitive treatment of open pneumothorax?

A

Closere of the chest wall defect + closed tube thoracostomy remote from the wound

53
Q

Definition of flial chest?

A

Fractures >/= 3 contiguous ribs in >/= 2 locations

54
Q

Most appropriate treatment for pneumothorax?

A

Insertion of chest tube drainage of the pleural space

55
Q

Physical exam findings of pneumothorax?

A
  1. Shortness of breath
  2. Unilateral chest pain
  3. Decreased breath sounds Ipsilateral side
  4. Hyperresonant on percussion of the ipsilateral side
56
Q

Palpable pulse and corresponding approximate systolic blood pressure

A
  1. Carotid SBP >60
  2. Femoral SBP >70
  3. Radial SBP >80

Up down out

57
Q

Hard signs of vascular injury

A
  1. Pulsatile hemorrhage
  2. Absent pulses
  3. Acute ischemia

Operation is mandatory if there are hard signs

58
Q

Hemorrhage class of an anxious and confused patient with hypotension, PR 130, RR 35, and UO 10ml / hr

A

Class III

59
Q

Cut off massive hemothorax in adults and children?

A

Adult >1,500ml
Children >25% blood volume

60
Q

Excision of a portion of the pericardium which allows drainage of cardiac tamponade?

A

Subxiphoid pericardial window

61
Q

Preferred test in the diagnosis of the cardiac tamponade?

A

Echocardiogram

62
Q

Formula to compute GCS in intubated patients or if they are unable to verbalize?

A

GCS= E + DVS + M
DVS= (0.5M + 0.4E)

63
Q

Signs of suspected basilar skull fracture ?

A
  1. Battle sign ( ecchymosis behind ear)
  2. Racoon eyes ( peri orbital ecchymosis)
  3. CSF rhinorrhea
  4. Otorrhea
64
Q

Temporizing maneuver for patients in impending herniation while awaiting definitive surgical management that decreases cerebral blood flow?

A

Hyperventilation

65
Q

6Ps of Compartment Syndrome?

A
  1. Pain
  2. Paresthesia
  3. Pallor
  4. Poikilothermy
  5. Paralysis
  6. Pulselessness
66
Q

Distal radial fracture with volar angulation?

A

Smith’s Fracture

Colle’s fracture: Distal radial fracture with dorsal angulation

67
Q

Proximal third ulnar fracture with dislocation of the radial head?

A

Monteggia fracture

68
Q

Middle distal third radial fracture with the dislocation of the radioulnar joint?

A

Galeazzi fracture

69
Q

Vertebra and its parts affected in Hangman’s fracture?

A

C2 pedicles

70
Q

Type of fracture where the bone is broken into three or more fragments?

A

Comminuted fracture

71
Q

Incomplete fracture in which the angulating force bends the cortex on the compression side and breaks it on the distraction site?

A

Greenstick fracture

72
Q

General principles of radiographic examination of fractures and dislocations ?

A
  1. Two views at right angles
  2. Includes joints above and below area of injury
73
Q

Restoration of normal alignment of bone via external manipulation of the fracture or dislocation?

A

Closed reduction

74
Q

Use of superficial incision to directly visualize and manipulate fracture / dislocation?

A

Open reduction

75
Q

Gustilo-Andersen open fracture classification of a fracture <1cm long with clean wound and evidence of vascular injury requiring repair. What grade?

A

IIIC

Presence of vascular injury elevates the fracture to Grade IIIC

76
Q

Antibiotics used to grade II open fractures?

A

1st gen Cephalosporins + Aminoglycosides

77
Q

Most common site of pressure injury ?

A

Ischial tuberosity 28%
Greater trochanter 18%
Sacrum 17%
Heel 9%

78
Q

Causes of Type II necrotizing soft tissue infections?

A

a-hemolytic streptococcus or staphylococcus

79
Q

Pro inflammatory mediators of shock? (7)

A

IL 1a/B
IL 2
IL 6
IL 8
Interferon
TNF
PAF

80
Q

Anti-inflammatory mediators of Shock ? (5)

A

IL 4
IL 10
IL 13
Prostaglandin E2
TGFB

Surgery (14 decks)

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