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Trauma & ED radiology > Trauma Review > Flashcards

Trauma Review Flashcards

1
Q

8 causes of spont. pneumo

A

Idiopathic (slender, tall), COPD, infection, neoplasms, sarcoid, marfans, endometriosis, crack smoking

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2
Q

How do you treat a pneumatocele

A

Not necessary

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3
Q

What does a lung contusion look like

A

Ill defined, patchy alveolar

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4
Q

Hypoxia, petechial rash, trauma, AMS

A

fat embolism possible

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5
Q

What does fat embolism look like on cxr

A

ARDS

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6
Q

If you fracture upper 3 ribs?

A

Think aortic injury

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7
Q

If you fracter lower 3 ribs?

A

think liver or splenic

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8
Q

What is the threshold for mediastinal widening?

A

8cm

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9
Q

What are five findings of aortic injury on CXR

A

Widening of mediastinum, downward displacement of LMSB, tracheal or esophageal displacement, apical capping, left pleural effusion

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10
Q

What is apical capping?

A

Density in the apices

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11
Q

What percentage of aortic rupture patients have normal cxrs initially?

A

seven %

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12
Q

What are signs of inhalation injury?

A

Subglottic edema, diffuse peribronchial infiltration, pulmonary edema, atelectasis.

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13
Q

What are later signs of inhalation injury?

A

pneumonia, ARDS, barotrauma, atelectasis, fluid overload

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14
Q

What would you see with obstructive aspiration?

A

hyperinflation of distal segment

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15
Q

What does radiation therapy look like on CXR?

A

profoundly geometric

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16
Q

When do you expect cardiac injury?

A

Blunt to chest with sternal fracture, or severe soft tissue injury

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17
Q

What are four manifestations?

A

Contusions (may have trops), rupture of chordae may lead to pulmonary edema, tricuspid injury, aortic dissesction and pericardial effusion

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18
Q

What are signs of vascular trauma

A

Hemorrhage, dissection, pseudoaneurysm, arterial spasm, thrombosis, AV fistula

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19
Q

Gold standard for PE?

A

Angio. BUT CTA is basically the best option since its not as invasive. Can use MRA

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20
Q

When would you use Angio?

A

When CTA is not diagnosis but there is concern, when there is an UNSTABLE person who might need intervention.

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21
Q

What are the five most common causes of thoracif aortic aneurysm

A

Athero, trauma, infection, cystic medial necrosis (connective tissue DO, HTN, syphylis), aortitis (colagen vascular dz, takayasu, GCA)

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22
Q

When does a thoracic AA need repair?

A

6cm

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23
Q

Where are most abdominal aneurysm found?

A

Abdominal

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24
Q

What does a mycotic aneurysm look like?

A

perianeurysmal inflammation!

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25
Q

What is the most common location for mycotic aneurysm?

A

ascending aorta and isthmus

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26
Q

What are the most common organisms?

A

Staph A, strep, salmonella, neisseria, mycobacteria tuberculosis

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27
Q

What are risk factors for aneurysms?

A

Ascending see above, descending see above but smoking!

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28
Q

What layer is torn in a dissection?

A

TUNICA

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29
Q

What are common causes of dissection?

A

HTN, marfans, athero, bicuspid aortic valve, coarct

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30
Q

What are the two classes of dissection?

A

Debakey, Stanford

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31
Q

Describe the two

A

Debakey: B A D, I: ascending/descending, II: ascending, III: descending. Stanford: A: ascending proxima to takeoff of left subclavian, B: descending

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32
Q

What is the treatment for types A or B?

A

A surgery, B medical

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33
Q

Complications of aortic dissection

A

Rupture, MI, tamponade, valvular insufficiency, Stroke, mesenteric ischemia, renal insufficiency, paraplegia

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34
Q

What causes most aortic injury?

A

Sudden decelleration

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35
Q

What are the three sites most often involved?

A

Injury at the Aortic Root, the Aortic isthmus, the hiatus of the diaphragm

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36
Q

What are plain film signs of aortic injury

A

Abnormally contoured arch and loss of knob, wide mediastinum, capping, left mediastinal stripe, widened paratracheal area, effusion, broken upper ribs, tracheal deviation

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37
Q

is it more likely to see root or isthmus injuries?

A

Isthmus 95% of time because root injuries die

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38
Q

Diagnostic imaging of choice for aortic injury?

A

CTA

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39
Q

When would you use Aortography?

A

rarely, only if CTA is equivocal or INTERVENTION is planned

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40
Q

What does aortic injury look like?

A

Pseudoaneurysm, intimal tear or defect, irregular contour, extravasation

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41
Q

What size is a AAA? What size requires intervention?

A

3cm. >5cm requires intervention

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42
Q

What are four signs of pneumoperitoneum?

A

Free air under the diaphram, Falciform outline (football sign), Rigler’s sign, air between the liver and abdomen on LLD

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43
Q

Five causes of pneumoperitoneum

A

ruptured viscus, surgery, pneumatosis intestinalis, steroid therapy (?), air forced through fallopian tubes

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44
Q

How long does post surgical free air last?

A

4-5 days

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45
Q

Causes of pneumatosis

A

Necrosis, emphysematous gastritis, ulcers, immunocompromise, pulmonary disease, overdistention

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46
Q

How to tell portal gas from bile duct gas?

A

Peripheral portal, central for bile. Think about where the FLOW is

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47
Q

Causes of pneumobilia?

A

ERCP, surgery, fistula, malignancy, gallstone illeus

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48
Q

Four radiographic signs of bowel obstruction

A

transition point, large dilation and fluid in proximal bowel, stair step sign (greater than 3 air fluid levels), string of pearls sign

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49
Q

Approach to patient with suspected BO

A

Plain films, CT can help with SBO. barium enema is good for LBO too

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50
Q

Why is the cecum most prone to rupture in distention?

A

Laplace’s law

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51
Q

What are the two categories of renal trauma?

A

Minor injuries (85%, nonsurgical hematomas, contusions, lacerations). Major: pedicular injuries, shattered kidney

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52
Q

What are the indications for angiography for trauma patients?

A

No visualization of kiney on IVP.

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53
Q

What are two types of bladder rupture?

A

Intraperitoneal, extraperitoneal

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54
Q

What causes extraperiotoneal rupture?

A

Pelvic fracture

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55
Q

What causes intraperitoneal rupture?

A

blunt trauma

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56
Q

What is a pear-shaped bladder indicative of?

A

Could be pelvic lipomatosis, IVC occlusion, lymphocele, pelvic lymphadenopathy, healthy patient with iliac muscle hypertrophy

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57
Q

What are the types of urethral injury?

A

I: periurethral hematoma with narrowing. II: rupture above orogenical diaphram. III: Rupture at the urogenital diaphram with superior displacement of the bladder

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58
Q

What is the initial treatment for urethral injury?

A

suprapubic

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59
Q

What is a straddle injury?

A

injury to soft tissue of bulbous urethra

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60
Q

What are the risks of urethral injury?

A

Stricture and impotence

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61
Q

What are the four signs of abuse?

A

Healing fractures of differing ages, multiple fractures, unusual fractures, metaphhyseal fractures

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62
Q

What fracture is pathognomonic for abuse?

A

bucket handle

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63
Q

When does periosteal new bone formation take place?

A

7-10 days

64
Q

When does obliteration of the fracture line show?

A

14-21 days

65
Q

When does hard callus formation show?

A

14-28 days

66
Q

When does remodeling of bone happen?

A

12 months

67
Q

What are five common types of fracture?

A

Elastic deformation, bowing deformation, torus fracture, greenstick fracture, Salter-Harris fracture

68
Q

What is the difference between elastic adn bowing deformations

A

Elastic will return to original, whereas bowing deformities stay

69
Q

What is a buckle fracture

A

bowing of one cortex

70
Q

what is a greenstick fracture?

A

incomplete fracture in one cortex and periosteal rupture on the opposite side, with intact periosteum on the cortically disrupted side

71
Q

What is a salter harris fracture

A

Fractures involving the epiphyseal plate

72
Q

What are the types?

A

I: fracture through the physeal plate. II: fracture through the metaphysis and physis. III: Fracture of epiphysis and physis. IV: fracture through all three structures. V: crushed physis

73
Q

SALTR

A

Separated, above, lower, through, ruined

74
Q

Where are the uncovertebral joints?

A

Luschka: They are cervical vertebral body-vertebral body joints

75
Q

What are facet joints

A

Facet joints are zygapophyseal joints created from the superior and inferior articular processes of the thoracic and lumbar

76
Q

At which levels do you have oncovertebral or facet joints

A

Cervical uncovertebral, thoracic is facet joints

77
Q

What are the three columns of the spine

A

Anterior, middle, posterior. Anterior is anterior part of vertebral body and anterior long ligament, middle is the posterior vertebral body and posterior long ligament, and posterior column is the flavum, interspinous, and all things posterior

78
Q

Conus at what level

A

T12

79
Q

What three bones are the shoulder girdle

A

scapula, clavicle, humerus

80
Q

What are the parts of the scapula?

A

acromion, coracoid, body, spine, glenoid fossa

81
Q

What are the muscles of the rotator cuff?

A

SITS: spuraspinatis, infraspinatus, teres minor, subscapularis

82
Q

Where is the subacromial bursa?

A

Deep to deltoid, superior to rotator cuff

83
Q

What muscle tendon (not rotator cuff) passes through the shoulder joint capsule?

A

Biceps long head

84
Q

How does the ulna and humerus articulate?

A

olecrenon process of ulna articulates with the trochlea and olecranon fossa of humerus

85
Q

How does the radius and humerus articulate?

A

Capitellum

86
Q

Bones of the wrist mnemonic?

A

So Long To Pinky, Here Comes The Thumb

87
Q

What are the four joints of the wrist?

A

Distal radiolunar, Radiocarpal, midcarpal, carpometacarpal

88
Q

What is the scapholunate angle?

A

measure from the axis that divides the concavity of the scaphoid, to the angle of the lunate, should be 30-60

89
Q

How does the scaphoid receive it’s blood?

A

distal to proximal

90
Q

What is ulnar variance? Normal, Neg/Pos?

A

Positive ulnar variance is when the ulna is longer than the radius. Normally the articular surfaces should be aligned.

91
Q

What four structures (nine items) are in the carpal tunel

A

Median nerve, superficial flexor, deep flexors, and flexor pollicis longus

92
Q

What are the parts of the metacarpal?

A

Base, shaft, neck, head

93
Q

Joints of the fingers?

A

Carpometacarpal, metacarpophalangeal, interphalageal, distal interphalageal

94
Q

What are the columns of the pelvis?

A

Anterior and posterior

95
Q

What is the posterior column?

A

From the sciatic notch to the ischial tuberosity

96
Q

What is the anterior column?

A

From the anterior superior iliac spine to the pubic symphysis

97
Q

Why are the columns important?

A

They determine sugical approach

98
Q

What is Shentons line?

A

Line from medial border of the femoral metaphysis and superior border of the obturator foramen – should be undisrupted and smooth!

99
Q

Identify important lines of the hip

A

Ileopectineal, ilioischial, anterior and posterior rim of acetabulum, shentons, acetabular roof

100
Q

How does the femoral head receive blood supply?

A

Mostly from retrograde arterial supply from the circumflex

101
Q

What are three articulations of the knee?

A

Medial tibiofemoral, lateral tibiofemoral, and patellofemoral

102
Q

What ar ethe stabilty forming ligaments of the knee?

A

ACL,PCL, MCL, LCL

103
Q

What are the bones of the hindfoot?

A

Talus, calcaneus

104
Q

What are the bones of the midfoot?

A

Navicular, cuboid, and three cuneiform bones

105
Q

What are the bones of the forefoot?

A

metatarsals, and phalanges

106
Q

WHAT ARE FIVE QUESTIONS you need to answer when looking at plain film?

A

Alignment, Soft tissue, joint spaces, bone density (sclerosis), cortex

107
Q

What is a stress fracture?

A

Either a fatigue or insufficiency. Both are types

108
Q

What are sites of fatigue fracture?

A

tibial shafts, metatarsals, distal fibula, femur, calcaneus, pars, navicular, pubic ramus

109
Q

What are predisposing conditions to insufficiency?

A

osteoporosis, osteomalacia, fibrous displasia, pagets, hyperparathyroidism, steroids

110
Q

What is the appearance of a stress fracture?

A

7-14 days after. sclerotic change, periostitis, cortical fracture

111
Q

What is the mnemonic for causes of osteonecrosis?

A

ASEPTIC

112
Q

What is ASEPTIC

A

alcohol, sickle, exogenous steroid, pancreatitis, trauma, idopathic, caisson disease (bends)

113
Q

What is OCD?

A

Osteochondritis Dessicans

114
Q

Where do you typically see OCD?

A

femoral condyles

115
Q

What are the radiographic features?

A

Joint effusion, radiolucent separation of the osteochondral fragment from the condyle. said to be from chronic trauma

116
Q

What is arthrodesis?

A

Fusion by removal of articular cartilage

117
Q

Dislocation vs subluxation?

A

Sublixation is subtotal loss of congruity.

118
Q

What is pathologic fracture?

A

Fracture associated around a nidus of disease such as tumor or infection

119
Q

What is occult fracture?

A

Not visible on plain film?

120
Q

What views should you get of a possible fracture site?

A

Two views taken at 90 degrees of each other, and also views of the joints above and below

121
Q

What films are required for trauma>

A

Lateral cervical, Chest, AP pelvic

122
Q

What four peices of info are required for adequate description of a fracture?

A

ANATOMIC SITE, FRACTURE PATTERN, ALIGNMENT, ASSOCIATED SOFT TISSUE INJURIES

123
Q

Anatomic Site

A

Bones injured, location, intra/extra articular involvement

124
Q

Fracture Patterns

A

Simple transverse, comminuted, oblique, spiral, longitudinal, impacted, depressed, avulsion

125
Q

Fracture alignment

A

Displacement, angulation, rotation, discrepany

126
Q

How is displacement described?

A

Location of the distal fragment

127
Q

Valgus?

A

Lateral distal movement, knock-knee

128
Q

Varus?

A

Medial distal movement, so this would be bowed legs

129
Q

What is pseduoarthrosis

A

Fracture nonunion leading to joint like creation with a synnovial like cavity.

130
Q

What is malunion, vs nonunion, reactive nonunion, vs infective nonunion?

A

Different types of nonunion. Malunion is union but not in anatomic alignment

131
Q

Myositis ossificans

A

Post trauma bone formation in a chronic hematoma in a muscle with a corticated and central lucency

132
Q

What types of things would you see in facial fractures?

A

Cortical disruption, fragment displacement, asymmetry, air fluid in sinuses, orbital emphysema, STS

133
Q

What view would you get for a nasal fracture?

A

Water’s view

134
Q

What is the most common zygomatic (tripod) arch fracture?

A

FIZL: frontozygomatic suture, infraorbital rim, zygomatic arch, lateral maxillary wall

135
Q

What is a Lefort fracture?

A

Fractures that always involve the pterygoid plates and vary in terms of their location through the CC facial structures.

136
Q

What are the most common levels of spinal fracture?

A

C1-C2, C5-C6, T10-T12

137
Q

Does spinal cord injury happen at the time of injury or later?

A

MOST will happen at the time of injury!

138
Q

What does flexion extension images show?

A

ligamentous injury or instability

139
Q

What is the pitfall of flexion extension films in acute setting?

A

Paraspinous musclulature can spasm, and give you a false negative. hense C collars for 1-2 weeks

140
Q

What is a jefferson’s fracture?

A

Axial loading, splitting of C1 posterior elements

141
Q

Describe dense fractures

A

Can be different types, some are stable some are unstable

142
Q

What is a Hangman’s?

A

hyperextension. C2 pars fracture.

143
Q

What is a teardrops?

A

Severe flexion, tear drop is the anterior vetebral body fragment. very unstable, SAD tear outcome

144
Q

What conditions are associated with C1-C2 subluxation

A

RA, JRA, psoriasis, AS, SLE, Downs, trauma

145
Q

What is a chance injury?

A

Horizontal fracture

146
Q

Anterior and posterior shoulder dislocation

A

Anterior is inferior, posterior you sometimes cant see on AP

147
Q

What are Bankart and Hill-Sachs

A

Bankart is injury to inferior glenoid, and hill-sachs is a depression in the humeral head. Both associated with anterior dislocation

148
Q

What is the posterior fat pad and sail sign?

A

Indicative of fractures of the elbow, hemarthrosis

149
Q

What is a Monteggia’s fracture?

A

Fracture of the ulna with radial head dislocation

150
Q

What is a Galeazzi’s fracture?

A

Fracture of the proximal radius with distal radioulnar dislocation

151
Q

What is a nightstick fracture?

A

Ulnar fracture distal diaphysis

152
Q

What is a Colles fracture?

A

Distal radial fracture falling on outstreatced extended pronated wrist.

153
Q

How would you asses for scaphoid fracture on physical exam?

A

anatomic snuffbox tenderness

154
Q

What makes a pelvic fracture unstable?

A

Ring disruption

155
Q

What are four common locations for pelvic avulsions

A

ASIS: sartorius avulsion, AIIS: rectus femoris, Ischia tuberosity: hamstring avulsion, Lesser trochanter: iliopsoas

156
Q

What’s the most common hip dislocation? why?

A

Posterior, knee to dashboard

Trauma & ED radiology (1 decks)

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