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Rosh Review > Trauma/Ortho > Flashcards

Trauma/Ortho Flashcards

1
Q

what is considered a low voltage injury

A

<240V

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2
Q

what is considered a high voltage injury

A

> 1000V

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3
Q

minimum assessment of someone with electrical injury

A
  • ECG

- skin examination

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4
Q

dispo for patients with high voltage electrical injury

A

observation for 12 hours to look for rhabdo, renal failure, cardiac disturbances

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5
Q

what are arc burns

A

flash electrical burns that do not penetrate deeper than the skin

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6
Q

what is more dangerous- AC or DC?

A

AC

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7
Q

what type of electrical injury draws a person to the electircal source

A

AC- flexor>extensor contractions draw the person to the source

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8
Q

DC currents are found in what

A

battery, lighting

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9
Q

treatment for stingray injury

A

immerse in warm water so it can break down poison (around 45C)

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10
Q

MC type of brain herniation from trauma

A

uncal herniation- temporal lobe pushes downward

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11
Q

nerve injured in posterior elbow dislocation

A

median nerve

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12
Q

nerve injured in humeral fracture

A

radial nerve

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13
Q

nerve injured in anterior elbow dislocation

A

ulnar nerve

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14
Q

frostbite with erythema and edema

A

first degree frost bite (epidermis)

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15
Q

frostbite with hard edema and clear blisters

A

second degree (epidermis and dermis)

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16
Q

frostbite with hemorrhagic bullae, pale gray extremity

A

third degree (hypodermis)

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17
Q

frost bite that is insensate, black/gray

A

fourth degree (skin, muscles, tendons, bones)

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18
Q

core temperature after drop after rewarming of frost bite

A

acidotic and hyperkalemic blood returns into circulation after extremity is rewarmed and vasoconstriction relieved

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19
Q

MC injury from penetrating abdominal trauma

A

hollow viscous injury

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20
Q

most injured organ in blunt abdominal trauma

A

spleen

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21
Q

laparotomy after blunt trauma indicated if

A
  1. HD unstable
  2. peritonitis
  3. free air on XR
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22
Q

hematoma above injuinal ligament after pelvic trauma

A

destot’s sign

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23
Q

delta pressure

A

DBP - intracompartment pressure

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24
Q

what delta pressure is suggestive of compartment syndrome

A

<30mmHg

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25
Q

normal compartment pressure

A

0-10mmHg

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26
Q

last finding in compartment syndrome

A

loss of pulses

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27
Q

complete loss of motor, pain, and temperature below lesion with preservation of proprioception and vibratory sensation

A

anterior cord syndrome

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28
Q

forced hyperextension injury with upper>lower weakness

A

central cord

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29
Q

management of flail chest

A

intubation

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30
Q

describe chest movements of flail chest

A

inspiration- piece of chest goes down, expiration, broken chest rises

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31
Q

mechanism of achilles tendon injury

A

plantar flexion against resistance

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32
Q

splint for achilles rupture

A

posterior splint with 20 to 30 degrees of plantar flexion

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33
Q

primary contraindication to nail trephination

A

disrupted nail edge

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34
Q

management of nail after trephination

A

antibiotic ointment and guaze dressing

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35
Q

what is associated with a proximal nail avulsion in a pediatric patient

A

seymour fracture- distal phalangeal physis fracture

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36
Q

indications for nail trephination

A

> 50 nail bed or pain regardless of size

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37
Q

only two treatments rendered in START triage

A

airway repositioning and direct pressure for hemorrhage control

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38
Q

enophthalmos

A

posterior displacement of the globe with an orbital blowout fracture

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39
Q

phalen’s test

A

bring dorsums of hands together and hold wrist in complete forced flexion for 30-60 seconds

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40
Q

finkelstein’s test

A

thumb in palm, ulnar deviate the wrist

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41
Q

risk factors for carpal tunnel

A

RA, obesity, diabetes, pregnancy, hypothyroidism

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42
Q

reproduction of symptoms with palpation over carpal tunnel

A

tinel’s sign

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43
Q

zone 1 injury location

A

clavicle to cricoid

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44
Q

zone 2 injury location

A

cricoid to mandible

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45
Q

zone 3 injury location

A

mandible to skull base

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46
Q

neck injury highest mortality

A

zone 1

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47
Q

most common cause of LOC after rapid descent from diving

A

arterial gas embolism

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48
Q

immediate treatment of arterial gas embolism

A

lay supine, oxygen by non-rebreather, IVF; definitive treatment is hyperbarics

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49
Q

nitrogen narcosis occurs when

A

descent >70 feet

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50
Q

mechanism of HAPE (High altitude pulm edema)

A

hypoxic vasoconstriction of pulm vessels leading to elevated pulm pressures and resultant endothelial damage and pulm edema

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51
Q

most common cause of death from high altitude illness

A

HAPE

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52
Q

what medication can be used to prevent high altitude illness

A

acetazolamide

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53
Q

initial agent that helps acclimatization and prevent high altitude illness

A

acetazolamide (also important to halt ascent)

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54
Q

patients allergic to what agents should avoid acetazolamide

A

sulfa drugs

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55
Q

tenderness along ulnar aspect of thumb with difficulty with pincer grasp

A

gamekeeprs thumb

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56
Q

treatment for gamekeepers thumb

A

thumb spica splint

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57
Q

dermatomome of nipple line

A

T4

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58
Q

biceps reflex dermatome

A

C5/C6

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59
Q

triceps reflex dermatome

A

C7

60
Q

patella reflex dermatome

A

L4

61
Q

achilles tendon dermatome

A

S1

62
Q

risk of delayed repair of popliteal injury

A

amputation rate >90%

63
Q

risk of untreated perilunate dislocation

A

median nerve compression, avascular necrosis, compartment syndrome, long-term disability

64
Q

perilunate dislocation most often associated with what other bone fracture

A

scaphoid

65
Q

bifirigency of gout crystals

A

negative

66
Q

which bone is referred to when talking about a dislocation

A

distal bone

67
Q

most commonly injured nerve in knee dislocation

A

peroneal nerve

68
Q

unstable patient + negative fast

A

repeat fast or DPL

69
Q

unstable patient + positive fast

A

laparotomy

70
Q

eyes moving in opposite direction of head turning

A

oculocephalic reflex, indicates intact brainstem

71
Q

best way to tell if laceration goes into joint

A

CT scan

72
Q

most common carpal bone fracture

A

scaphoid fracture

73
Q

treatment of high altitude for cerebral edema

A

dexamethasone and oxygen

74
Q

pulmonary sequelae of near-hanging

A

pulmonary edema, bronchopneumonia, and ARDS

75
Q

two types of pulmonary edema after hanging

A
  1. neurogenic- centrally mediated sympathetic discharge

2. post-obstructive pulm edema

76
Q

what to avoid in head injury patients in terms of MV

A

avoid hypercapnea

77
Q

damage of peroneal nerve causes what

A

foot drop

78
Q

vascular structure at risk with injury to the proximal fibula

A

anterior tibial artery

79
Q

damage to tibial nerve causes

A

decreased foot inversion and plantar-flexion

80
Q

damage to inferior gluteal nerve causes

A

decreased hip extension

81
Q

which odontoid fractures are considered unstable

A

type 1 (stable), type 2 (unstable), type 3 (unstable)

82
Q

direct effect from blast shockwave

A

primary blast trauma

83
Q

impact of fragments from blast shockwave

A

secondary blast trauma

84
Q

blast wave propels patient into object

A

tertiary blast trauma

85
Q

most common blast injury

A

tympanic membrane rupture

86
Q

indications for non-op management of fingertip amputations

A

no bone or tendon exposed, and less than 2cm of skin loss

87
Q

compare jones and pseudo-jones fractures

A

jones is through base of 5th MT, pseudo jones is avulasion fracture through the tuberosity (proximal to articulation between base of 4th and 5th MT)

88
Q

indications for reduction in a boxer’s fracture

A

> 40 degrees angulation-> ulnar gutter splint

89
Q

alkali causes what kind of necrosis

A

liquefactive

90
Q

destot’s sign

A

hematoma above the inguinal ligament

91
Q

what should be done before foley placement in pelvic fracture

A

urethrogram

92
Q

treatment for decompression illness

A

fluids, O2, position in left lateral decubitis in mild trendelenberg, hyperbaric O2

93
Q

prognosis for decompression illness

A

symptoms usually resolve but some people have symptoms that last months

94
Q

scuba diver who develops confusion and hallucinations during descent- dx and mechanism

A

nitrogen narcosis caused by increased pO2 in CNS

95
Q

five causes of death from blunt cardiac injury

A
  1. dysrhythmias
  2. acute heart failure
  3. cardiac free wall rupture
  4. laceration of coronary artery
  5. rupture of atrial or ventricular septum
96
Q

most common valve injured in blunt cardiac injury

A

aortic-> AR

97
Q

how good is ECG at ruling out blunt cardiac injury

A

80-90% predictive value if it is normal

98
Q

+ECG or troponin in blunt cardiac injury should lead to what next test

A

echocardiogram

99
Q

MI on ECG + positive biomarkers after blunt cardiac injury-> next step

A

serial biomarkers, consultation with cards and cardiac surgery

100
Q

bony, hard swelling of DIP are pathognomonic for what

A

OA (heberden nodes)

101
Q

compare XR of RA vs OA

A

periarticular bone loss-> RA

joint space narrowing/osteophytes-> OA

102
Q

Most common hip dislocation

A

posterior

103
Q

3 things that can get injured in a posterior hip dislocation

A
  1. sciatic nerve
  2. femoral nerve
  3. femoral artery
104
Q

most common fracture associated with a hip dislocation

A

acetabular fracture

105
Q

name the shoulder reduction technique-> lie prone and hold weight

A

stimson method

106
Q

risk of hippocratic method for shoulder reduction

A

axillary nerve injury

107
Q

most common type of odontoid fracture

A

type 2

108
Q

describe type 1 odontoid fracture

A

avulsion of tip

109
Q

describe type 2 odontoid fracture

A

fracture at junction of base of odontoid and body of C2

110
Q

describe type 3 odontoid fracture

A

fracture through upper portion of body of C2

111
Q

bilateral facet dislocations- stable or unstable

A

unstable

112
Q

describe galeazzi

A

distal radius fracture with distal radioulnar joint dislocation

113
Q

describe monteggia fracture

A

proximal to mid ulna fracutre, radial head dislocation`

114
Q

what nerve is at risk of injury from galeazzi fracture

A

anterior interosseous nerve, branch of median nerve

115
Q

treatment of boutenierrre’s deformity

A

splint PIP in extension

116
Q

forefoot pain against a stabilized hindfoot

A

lisfranc fracture

117
Q

most common complication of lisfranc injury

A

posttraumatic arthritis

118
Q

compare acute mountain sickness and high altitude cerebral edema

A

acute mountain sickness- no neuro deficits (may have lightheadedness, headache, GI upset). HACE needs to be treated with descent immediately.

119
Q

complications of perilunate dislocations

A

median nerve injuries, avascular necrosis

120
Q

dose of propofol in procedural sedation

A

0.5 to 1mg/kg titrated to effect

121
Q

indications for thoracotomy after chest tube placement

A

initial output of >20ml/kg (or 1500mL) or subsequent output of >200ml/hr

122
Q

smallest amount of fluid that can be seen on a FAST exam

A

75-250cc

123
Q

compartment pressure that indicates need for fasciotomy

A

> 30mmHg

124
Q

how to calculate delta pressure in compartment syndrome

A

DBP-direct pressure

125
Q

what is more reliable for compartment syndrome and why

A

delta pressure becuase it is thought that a normotensive patient can tolerate an elevated direct pressure better (delta pressure <30 suggests compartment syndrome)

126
Q

single, large, free-floating segment of tibia bone between two well-defined fracture lines

A

segmental fracture

127
Q

most common long bone fracture

A

tibia fracture

128
Q

splintering or shattering of bone from high mechanism injury

A

comminuted

129
Q

posterior elbow dislocation can cause damage to what artery and nerve

A

brachial artery and ulnar nerve

130
Q

which type of burns are included in parkland

A

anything but superficial

131
Q

compare superficial to superficial partial burns

A

superficial- sun burn

superficial partial- blisters

132
Q

rim sign

A

distance between glenoid rim and humerus is increased in posterior shoulder dislocation

133
Q

compression fracture of posterolateral humeral head after should dislocation

A

hill sach’s deformity

134
Q

fracture associated with posterior shoulder dislocation

A

reverse hill sachs

135
Q

describe hawkins test and what it’s used for

A

shoulder abduction to 90 degrees with shoulder internal rotation

136
Q

pain in the anterior shoulder with radiation to biceps

A

biceps tendinitis

137
Q

Most serious complication of elbow dislocation

A

Brachial artery injury

138
Q

segund fracture associated with what ligamentous injury

A

ACL

139
Q

Nerve injury from anterior knee dislocation

A

Common perineal (can’t dorsiflex foot)

140
Q

Most common cause of death after strangulation

A

Pulmonary edema (cardiogenic and neurogenic)

141
Q

Bilateral pedicure fractures of C2

A

Hangman’s fracture

142
Q

Unilateral facet joint dislocation- stability and management

A

Stable, consult ortho

143
Q

What level of spinal cord compression causes weakness in plantar flexion

A

S1

144
Q

Normal ABI

A

> 0.9, ankle to brachial

145
Q

position of dislocated shoulder

A

abducted and externally rotated

Rosh Review (17 decks)

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