Trauma PP Flashcards
The following wounds should not be closed by primary (MCQ)
- intent Inflamed wound
- Bite wound
- Gunshot wound
- Older than 24 hours
All of the above
Laparotomy is not mandatory in penetrating abdominal injury in the following situations
- There is no such situation
- Normal white blood cell count
- No free air in the stomach
- If the greater omentum closes the wound
- If the wound is close to the liver
- There is no such situation
How do you preserve an amputated organ in the field?
- Sterile physiological solution
- In sterile gauze and put in a waterproof plastic bag which is placed in an other plastic bag containing ice water
- In betadine solution or any other disinfectant
- In the patient’s pocket
- None of the above
- In sterile gauze and put in a waterproof plastic bag which is placed in an other plastic bag containing ice water
The following statements are true about pertrochanteric fractures (MCQ)
- Intracapsular fracture
- Symptoms are that the affected limb is shortened, is in external rotation, the patient cannot actively raise it
- Avascular necrosis is a common sequelae
- Primary stabilization can be done with skin or skeletal extension
2 and 4
- Symptoms are that the affected limb is shortened, is in external rotation, the patient cannot actively raise it
- Primary stabilization can be done with skin or skeletal extension
Weber type classification of ankle fractures are graded as to how the level of the fibular fracture relates to the the syndesmosis (1), therefore type A fractures are supination injuries and type B and C fractures are pronation injuries (2)
a. 1 and 2 are correct and related
b. 1 and 2 are correct but not related
c. 1 is true, 2 is false
d. 1 is false, 2 is true
e. 1 and 2 are both false
b. 1 and 2 are correct but not related
The following statements are true about acute compartment syndrome: (MCQ)
- Early symptoms are pain, paresthesia, tenderness upon muscle extension
- Typically the injury of the thoracic cavity necessitating drainage
- Treated by acute decompression by performing fasciotomy
- Often due to an intercostal artery bleeding
1 and 3
- Early symptoms are pain, paresthesia, tenderness upon muscle extension
- Treated by acute decompression by performing fasciotomy
Which of the following is innervated by the median nerve? (MCQ)
- M. Abductor pollicis
- M. Flexor pollicis
- M. Flexor digitorum profundus
- M. Opponens pollicis
All
What kind of injuries would you look for when you find a deep laceration wound at the flexor surface a finger? (MCQ)
- Flexor tendon injury
- Extensor tendon injury
- Digital nerve injury
- Nail injury
1 and 3
- Flexor tendon injury
- Digital nerve injury
An elderly woman is brought into the ER after she fell and a hip fracture is suspected. She cannot bear weight on the affected side. There is no visible fracture on the x-ray. What to do? (MCQ)
- Painkillers are given, no further treatment is needed
- MRI because occult primary fractures often does not show up on x-ray
- Send her to rehabilitation, no further treatment is needed
- Do a follow up x-ray in 10 days, meanwhile give her pain med and try to mobilize the patient
4
- Do a follow up x-ray in 10 days, meanwhile give her pain med and try to mobilize the patient
After dull lumbar injury, the CT exam shows laceration and rupture of the left kidney. The kidney must be removed. The following exams are needed before surgery (multiple)
- Ultrasound
- Angiography
- MRI
- Urography to check the function of the opposite kidney
4
- Urography to check the function of the opposite kidney
Functional hand position: (MCQ)
- The MP joints are bent in 60-90 degrees
- The wrist is in 90 degree flection
- The PIP joints are bent in 20-30 degree flexion
- The wrist is in 30 degree ulnar duction
1 and 3
- The MP joints are bent in 60-90 degrees
- The PIP joints are bent in 20-30 degree flexion
Intraosseous infusion into the bone marrow (MCQ)
- Is appropriate for the urgent administration of medicine and liquids when venous access is not possible
- Is the recommended way for blood transfusion in infants
- Is usually accessed through the tibia
- Is a routine daily method for venous access in adults
1 and 3
- Is appropriate for the urgent administration of medicine and liquids when venous access is not possible
- Is usually accessed through the tibia
Which statement(s) is/are true about pediatric trauma? (MCQ)
- Not different than adult fracture care
- After conservative treatment, children experience more severe stiffness of joints
- There are more surgical indications than in adults
- After epiphyseal separations, the child needs to be monitored long enough to diagnose a possible growth arrest
4
- After epiphyseal separations, the child needs to be monitored long enough to diagnose a possible growth arrest
Treatment principles of pediatric diaphyseal injuries are (MCQ)
- Do not stimulate or damage the periosteum and the function of the epiphyseal cartilage
- Kill the macromovements
- Elastic stable intramedullary nailing is a treatment possibility
- Open reduction is mandatory to restore rotational and lateral dislocation
1, 2 and 3
- Do not stimulate or damage the periosteum and the function of the epiphyseal cartilage
- Kill the macromovements
- Elastic stable intramedullary nailing is a treatment possibility
What is the Wallace rule?
- Classification of lateral malleolar fractures
- Provides a quick, approximation of the blood loss in polytrauma
- Provides a quick, approximation of the area of skin burnt
- Determines the survivorship of spine injury
- . Advice for wound treatment
- Provides a quick, approximation of the area of skin burnt
What is true for pathological bone healing? (MCQ)
- It can be a result of poor blood supply
- Non-union can be treated by improving fixation, removing the end layer of bone to provide raw ends for healing, and the use of bone grafts
- Patients who smoke have a higher incidence of non-union
- If non-union is still evident 2 months post injury, it will remain unhealed without specific treatment
1, 2 and 3
- It can be a result of poor blood supply
- Non-union can be treated by improving fixation, removing the end layer of bone to provide raw ends for healing, and the use of bone grafts
- Patients who smoke have a higher incidence of non-union
Which of the following is/are typical for concussion (commotio cerebri) (MCQ)
- Blow to the head
- Transient loss of consciousness
- Complete recovery
- Incomplete recovery
1, 2 and 3
- Blow to the head
- Transient loss of consciousness
- Complete recovery
What is forbidden to do with a bite wound?
- Clean up the wound
- Excise the wound
- Give antibiotics
- Suture the wound
- Use plaster
- Suture the wound
Which of thefollowing is/are true concerning distal fractures of the radius? (MCQ)
- Smith fracture is an extraarticular, palmar dislocated fracture of the radius
- Barthon fracture is an intraarticular fracture of the radius
- Colles fracture is an extraarticular, dorsal dislocated fracture of the radius
- Rolando fracture Is an intraarticular, palmar dislocated fracture of the radius
1, 2 and 3
- Smith fracture is an extraarticular, palmar dislocated fracture of the radius
- Barthon fracture is an intraarticular fracture of the radius
- Colles fracture is an extraarticular, dorsal dislocated fracture of the radius
Which of the following is/are true for avulsion fractures? (MCQ)
- They are caused by traction, a bony fragment is torn off by a tendon or a ligament
- They are fractures in cancellous bones as a result of compression
- Examples include Weber A fracture, olecranon fracture
- They are typical for distal radius fractures
1 and 3
- They are caused by traction, a bony fragment is torn off by a tendon or a ligament
- Examples include Weber A fracture, olecranon fracture
Which is the first phase of the bone healing process?
- Remodeling phase
- Reparative phase
- Inflammatory phase
- Catabolic phase None of the above
- Inflammatory phase
What are the solid signs of bone fracture? (MCQ)
- Pathological immobility
- Pain
- Crepitation
- Elastic fixation
1, 2 and 3
- Pathological immobility
- Pain
- Crepitation
The following statements are true about knee dislocations (MCQ)
- Relative rare
- Acute reduction is needed
- Circulation has to be controlled
- Early or late ligament reconstruction is needed
All
The following statements apply for femur diaphysis fractures: (MCQ)
- Since the injury is intracapsular, the blood loss is minimal
- Best treatment is intramedullary nailing
- Conservative treatment is recommended
- External fixation is an option in case of polytraumatized patients (ARDS etc)
2 and 4
- Best treatment is intramedullary nailing
- External fixation is an option in case of polytraumatized patients (ARDS etc)
The following statement(s) is/are true about plaster application (MCQ)
1. Circular plaster should be applied in case of fresh trauma and postoperatively
2. After applying a cast on a fresh trauma patient, observation is necessary, especially for the symptoms of
compartment syndrome, pain, capillary filling, sensation, range of motion
3. Use hot water, so that the cast can be remodeled for a longer time
4. Thrombosis prophylaxis is necessary in lower extremity casts
2 and 4
- After applying a cast on a fresh trauma patient, observation is necessary, especially for the symptoms of
compartment syndrome, pain, capillary filling, sensation, range of motion - Thrombosis prophylaxis is necessary in lower extremity casts
Case with dull thoracic injury: the patient is battling for breath, has dilated cervical veins. What do you think? (MCQ)
- Injury to the aorta
- Tension PTX
- Tracheal injury
- Pericardial tamponade
2 and 4
- Tension PTX
- Pericardial tamponade
What is the correct treatment of femoral neck fractures? (MCQ)
- Bed rest for 6 weeks
- Prosthesis implantation
- Extension for 3 weeks followed by plaster application
- Acute osteosynthesis (screwing)
2 and 4
- Prosthesis implantation
- Acute osteosynthesis (screwing)
The following can be determined by the Glasgow coma scale (MCQ)
- Motor response
- Verbal response
- Eye opening
- Pupillary response
1, 2 and 3
How can you diagnose a spleen injury? (MCQ)
- Ultrasound
- CT
- Diagnostic peritoneal lavage
- Scintigraphy
1, 2 and 3
A case of dull abdominal trauma. CT shows a 3cm intraparenchymal hematoma in the spleen. What to do? (MCQ)
- Splenectomy as soon as possible
- Laparoscopy
- Observe for 48 hours and do a follow-up CT
- 3 weeks of observation with ultrasound, labs and CT if needed
4
- 3 weeks of observation with ultrasound, labs and CT if needed
What is a red line on the lower arm after a hand infection
- Sepsis
- Lymphangitis
- Phlegmone
- Thrombophlebitis
- Bacteremia
- Lymphangitis
What injuries are typical for elderly age? (MCQ)
- Femoral neck fracture
- Distal radius fracture
- Pertrochanteric fracture
- Tear of the medial meniscus
1, 2 and 3
What is the name of the partial fracture of the periosteum in childhood resulting only in bending?
- Pathological fracture
- Stress fracture
- Pseudoarticulation
- Greenstick fracture
- Prefracture state
- Greenstick fracture
Where is “no mans land”?
- At the fingertips
- In the palm
- At the dorsal surface of the hand
- Along the hand’s flexor tendon sheaths
- At the volar surface of the wrist
- Along the hand’s flexor tendon sheaths
What is the proper treatment of simple rib fractures? (MCQ)
- Bed rest
- Antibiotics
- Bandage of the broken rib
- Pain medication, expectorants
4
- Pain medication, expectorants
The following is true for reamed intramedullary nailing (MCQ)
1. There is a risk of fat embolism
2. Exhaustion fracture of the implant occurs more often than in case of unreamed intramedullary nailing
3. Promotes upsetting at the fracture site and results in greater stability than unreamed nailing due to better
fitting index
4. It is used for fixation of lumbar vertebral fractures
1 and 3
What to do in case of a wound infection?
- Antibiotics
- Wet wrapping
- The treatment depends on the patient’s body temperature
- Remove a few stitches
- Early wound exposure, open treatments, bacterial culture
- Early wound exposure, open treatments, bacterial culture
Definition of polytrauma (MCQ)
1. The same cause of injury leads to the lesion of multiple body regions or organs
2. At least 5 persons are injured at the same time
3. Multiple extremities are injured at the same time
4. Injury of one or more body cavities accompanied by limb injury. The accompanying injuries aggravate the
leading injury making it life threatening
4?
What type of hand immobilization is NOT correct? (MCQ)
- Fist bandage
- Finger immobilization by aluminum splint
- Volar plaster splint
- MP joints splinted in extended position
All
What belongs to the rotator cuff? (MCQ)
- Supraspinatus tendon
- Biceps long head tendon
- Subscapularis tendon
- Quadriceps tendon
1 and 3
What is Hangman’s fracture?
- Odontoid fracture
- C1 fracture
- Compression fracture of C3-C7
- C7 spinal process fracture
- C2 pedicle fracture
- C2 pedicle fracture
Traumatic hip dislocation, which statement is true? (MCQ)
- Posterior dislocation is the most common form
- It can be complicated with acetabular posterior wall fracture
- Femur head fracture may occur
- Late complications include aseptic femoral head necrosis
All
Following chest trauma, there is crepitation on the chest wall. What is the most likely cause?
- Anaerobe infection
- Subcutaneous emphysema
- Tension PTX
- Air is in the subcutaneous tissues after lidocaine injection
- Hematoma and PTX
- Subcutaneous emphysema
What kind of diagnostic procedure is appropriate to localize an intracranial bleed? (MCQ)
- CSF exam
- Glasgow coma scale
- Fundus examination
- CT
- CT
What cranial injury is the most urgent?
- Scalp laceration
- Epidural hematoma
- Contusion
- Intracerebral bleeding
- Impression cranial fracture
- Epidural hematoma
What is the therapy of upper thoracic vertebral fractures with no neurological symptoms, and less than 50% vertebral compressions?
- Pain relief, early mobilization
- Surgery
- Crutchfield extension
- Decompression
- Immobilization by plaster
- Pain relief, early mobilization
Case: explosion, burn wounds on face and chest, hoarseness and coughing. What to do FIRST?
- Intubate due to burn injury of the trachea
- Intubate because of serious lung damage
- Don’t intubate, give IV fluids due to the burns
- Don’t intubate, the breathing is satisfactory
- Give major pain relief (morphine)
- Intubate due to burn injury of the trachea
NO neurological focal signs are seen in
- Concussion
- Contusion
- Epidural hematoma
- Subdural hematoma
- Intracerebral bleeding
- Concussion
Concussion - LOC and negative CT