Trauma And Ortho And Rheum - James Ward

Front 1

list blood loss volumes for the 4 classes of shock

Back 1

I: <750
II: 750-1500
III: 1500-2000
IV: >2000ml

Front 2

scoring for the motor part of GCS

Back 2

I: no movement
II: extensor posturing
III: flexor posturing
IV: withdraws to pain
V: localizes to pain
VI: perposeful movement

Front 3

Canadian CT head rule

Back 3

GCS <15 2h after injury
suspected open or depressed skull fracture
any sign of basal skull fracture
vomiting >= 2 episodes
age >65
preimpact amnesia >30 min
dangerous mechanism (ped vs mvc, ejection, fall >3ft)

Front 4

Canadian CT neck rule

Back 4

1. None of :
age >65
parasthesias
mechanism (>3ft/5stair, axial load, >100km/h, roll over/ejection, ATV)
2. plus one of the following: ambulatory at any time, delayed onset of pain, simple rearend MVC
3. then check neck rotation

Front 5

type of fracture and mechanism

Back 5

Jefferson Fracture (burst of C1) from an axial load

note the overhanging edges of C1 on C2

Front 6

name and mechanism

Back 6

Bilateral facet dislocation
flexion injury
see greater than 50% anterior dislocation of vertebrae
Unstable injuruy

Front 7

types of odontoid fractures

Back 7

I: stable
II: unstable
III: unstable

Front 8

name and mechanism

Back 8

Hangman fracture
C2 bilateral pars interarticularis fractures
caused by hyperextension

Front 9

name and mechanism

Back 9

Extension or Flexion teardrop fracture
Unstable

Front 10

name and mechanism

Back 10

flexion-distraction (Chance fracture)
Horizontal fracture though middle and posterior columns
most commonly from flexion in MVC wearing lap belt

Front 11

Anterior Cord Syndrome

Back 11

Mechanism: Flexion of cervical v. or direct anterior cord injury
Findings: paralysis, loss of pain and temp, preserved proprioception and vibration

Front 12

name and function of each tract

Back 12

green- dorsal column: proprioception, vibration,
red- lateral corticospinal tract: motor function
blue- spinothalamic tract: pain, temperature, touch

Front 13

Central Cord Syndrome

Back 13

Mechanism: typically elderly hyperextension injury
Findings: Motor impairement in upper>lower limbs, and also variable touch, temperature, bladder dysfunction

Front 14

Brown-SeQuard Syndrome

Back 14

Hemisection of cord
Findings: Ipsilateral loss of motor, vibration, sensation and contralateral loss of pain and temp

Front 15

Chest tube output requiring thoracotomy

Back 15

>1500ml immediately or >200ml/h x 2 hr

Front 16

Beck's Triad

Back 16

1. Muffled heart sounds
2. JVD
3. Hypotension

Front 17

ED thoracotomy indications

Back 17

1. Arrest within 15min of presentation after penetrating chest trauma
2. SBP <50 after fluids with pen chest trauma
3.

Front 18

P/E for posterior hip dislocation

Back 18

shortened, internally rotated, and adducted

Front 19

Young and Burgess Pelvic fractures

Back 19

1. Lateral compression: fracture rami and/or iliac wings
2. Ant/Post compression: opens pubic symphysis and if opens SI joints called "open book"
3. Vertical Shear: fall from height causes shear of SI joint

Front 20

Penile fracture

Back 20

fracture of corpus cavernosum
Tx: surgical evacuation and repair tunica albugin

Front 21

Neck zones

Back 21

I: clavicles to cricoid
II: cricoid to angle of mandible
III: angle of mandible to base of skull

Front 22

Penetrating neck trauma: hard and soft signs

Back 22

Hard: expanding hematoma, pulsatile bleeding, air bubbling from wound, hematemesis, bruit, stridor, decreased/absent radial pulse

Front 23

compartments of the lower leg

Back 23

Anterior
Superficial Posterior
Deep Posterior
Lateral

Front 24

Findings of compartment syndrome

Back 24

Pressure (tense compartment)
Pallor
Pulselesness (late)
Pain out of proportion
Pain with passive stretch
parasthesias

Front 25

Normal compartment pressures:

Back 25

Normal 0-10mm Hg
>20 mm Hg is abnormal

Front 26

Urine findings of rhabdomyolysis

Back 26

blood on dip and minimal/no RBCs on analysis

Front 27

Parkland Formula

Back 27

4ml x %BSA x Wt in kg = fluids over 24hrs
(only count 2nd and 3rd degree)
give half in first 8hrs

Front 28

degrees of burns

Back 28

1st: epidermis, red, no blisters
2nd superficial: partial dermis, blistering, red, painful, blanching
2nd deep: partial dermis, blistering, non-blanching, red to pail white, painful
3rd: full dermis, charred, black or white, non painful, leathery, impaired touch sensation
4th: into subcutaneous, bone, muscle

Front 29

Acid burns

Back 29

Coagulative necrosis: causes an eschar barrier so burns less deep

Front 30

Alkali burns

Back 30

Liquefactive necrosis: no barrier formed and burns can be deeper than acids

Front 31

Elbow imaging lines?
Radiocapitellar line

Back 31

Anterior humeral line: should pass thought middle 1/3 of capittellum

Line from radius intersects middle 1/3 of capitellum

Front 32

Monteggia fracture

Back 32

Ulnar shaft fracture with radial head dislocation

Front 33

Galeazzi fracture

Back 33

radial shaft fracture with disruption of DRUJ
*unstable and requires ORIF

Front 34

injury and x ray finding

Back 34

scapholunate dissociation
Terry Thomas sign (widening of scaphoid-lunate space)

Front 35

injury and xray finding?

Back 35

Lunate dislocation
spilled tea cup sign

Front 36

Injury and x ray findings?

Back 36

Perilunate dislocation
Lunate properly aligned with radius but capitate not aligned with lunate

Front 37

Ulnar collateral ligament injury. Findings?

Back 37

From valgus stress to 1st phalanx
Tender over proximal 1st phalanx
laxity of 1st phalanx to valgus stress

Front 38

acceptable volar angulation of metacarpal neck fractures

Back 38

5th: <40 degrees
4th: <30 degrees
2nd and 3rd: <10 degrees
(2nd and 3rd are less mobile)

Front 39

Flexor digitorum profundus avulsion injury findings and treatment?

Back 39

unable to flex DIP with PIP and MCP held in extension.
Requires splinting and ortho referral for surgery

Front 40

Extensor tendon rupture findings and treatment

Back 40

unable to extend DIP
6 weeks of splint in extension

Front 41

Neer Classification

Back 41

Proximal humerus fractures
4 parts: greater tubercle, humeral head, lesser tubercle, shaft
count part: separation by 1cm or angulation of >45 degrees

Front 42

Ottawa Knee rules

Back 42

X ray if any of the following:
1. Unable to bear weight x 4 steps
2. Tender only over patella
3. tender over fibular head
4. age >55
5. Inability to flex to 90 degrees

Front 43

Inury?

Back 43

high riding patella indicates patellar tendon rupture.
See suprapatellar gap and low riding patella with quadriceps rupture

Front 44

Lachman's test?

Back 44

Tests ACL
anterior forse with knee in 30 degrees flexion
more sensitive than anterior drawer

Front 45

injury to knee from rapid deceleration and pivoting (ie. soccer)

Back 45

ACL

Front 46

Ottawa Ankle rules

Back 46

X ray if malleolar pain and any of:
1. Pain at base of 5th MT
2. Pain over navicular
3. Inability to wt br 4 steps at injury and in ED
4. Pain to posterior 6cm or tip of either malleoli

Front 47

Maissoneuve fracture? and Tx?

Back 47

Eversion injury
Medial malleolus # or deltoid disruption with disruption of syndesmosis and proximal fibula #
ORIF

Front 48

Normal Bohler's angle?

Back 48

<20 degrees
if less consider calcaneus fracture

Front 49

Lisfranc injury

Back 49

Disruption of ligament between 1st cuneiform and 2nd metatarsal.
Look for gap between 1st and 2nd or 2nd and 3rd metatarsal or X ray.
Requires ORIF.

Front 50

Most common pathogen in osteomyelitis?

Back 50

Staph aureus

Front 51

Microscopic findings of gout? crystals made of? Treatment?

Back 51

Needle shaped negatively birefringent crystals.
Uric Acid
Treat with NSAIDs +/- colchicine

Front 52

Pseudogout findings on microscopy? Crystals made of?

Back 52

rhomboid shaped positively birefringent crystals.
Calcium pyrophosphate

Front 53

Synovial fluid findings in septic joint?

Back 53

WBC> 50 000
>90% neutrophils
gram stain + in only about 50%

Front 54

causes of septic joint?

Back 54

Staph aureus most common.
Consider N. Gonnorrhea in sexually active

Front 55

tests for carpal tunnel

Back 55

Phalen's test: symptoms with hyperflexion of wrists for 90 seconds
Tinnel's sign: median nerve parasthesias with tapping tunnel

Front 56

De Quervan's Tenosynovitis pathology, testing, Tx?

Back 56

Synovitis of abductor pollicis longus and the extensor pollicis brevis.
Finklesteins test: pain at radial styloid with passive ulnar deviation wrist with hand in fist and thumb inside
RICE, NSAIDS, +/- steroid injection

Front 57

Flexor Tenosynovitis findings?

Back 57

Flexed posture of digit
Pain with passive extension
diffuse swelling
pain with palpation of flexor sheath

Front 58

Supracondylar humeral # classification

Back 58

Gartland classification
I: anterior cortex broken but no angulation/displacement
II: anterior cortex broken, angulate posteriorly with posterior cortex intact
III: completely displaced (no cortex intact)

Front 59

fracture and treatment

Back 59

Tillaux fracture:
A pediatric Salter-Haris type 3 to the anterior lateral aspect of the tibia. Requires ORIF

Front 60

Dequervain's tenosynovitis

Back 60

inflammation of extensor tendons of thumb
pain with flexion (finklesteins test)
Tx: steroid injection

Front 61

Flexor Tenosynovitis signs?

Back 61

swelling of finger
pain with passive extension
pain with proximal palpation flexor tendon (palm/wrist)
hand held in flexion

Front 62

Spinal stenosis

Back 62

caused by narrowing of lumbar canal
pain with sitting
wknss, parasthesias
Tx: PT +/- surgery

Front 63

Central Cord syndrome

Back 63

upper limbr>lower limb wknss

Front 64

Anterior cord syndrome?

Back 64

Impaired pain and temp
intact vibration, and proprioception

Front 65

Brown Sequered syndrome

Back 65

penetrating partial transection of cord
contralateral sensory deficits and ipsilateral motor deficits

Front 66

Tilleau fracture?

Back 66

Salter-Harris III of the medial aspect of distal tibia

Front 67

Back 67

jones fracture
Stress fracture of base of 5th
cast vs surgery

Front 68

Back 68

Dancer's fracture
avulsion of base of the 5th during inversion injury
Tx: cast

Front 69

Gout

Back 69

Uric Acid
negatively birefringent crystals
needle like crystals
Tx: NSAIDs

Front 70

Pseudogout

Back 70

Calcium pyrophosphate
positively birefringent rhomboid crystals
Tx: NSAIDS

Front 71

polymyositis

Back 71

proximal muscle pain and weakness
if there is a rash- dermatomyositis
elevated CK

Front 72

Polymyalgia Rheumatica

Back 72

Fever, pain in neck, shoulders, hips
associated with temporal arteritis
elevated ESR, CRP
Tx: steroids

Front 73

SLE diagnostic test and symptoms

Back 73

ANA
malar rash, polyarthralgia, multiple organ dysfunction

Front 74

Sjorgren's syndrome

Back 74

dry eyes and dry mouth
progressive destruction of salivary/lacrimary glands

Front 75

NEXUS rule?

Back 75

N- neuro findings (parasthesias, wknss)
S- spinal tenderness
A- altered LOC
I- intoxication
D- distracting injury

Front 76

Unstable C-spine fractures and pneumonic?

Back 76

Jefferson Bit off a hangman's ***
Jefferson
Bilateral facet dislocation
Odontoid fractures (type 2 and 3)
Atlanto-occipital dislocation
Hangmans
Teardrop

Front 77

Jefferson

Back 77

C1 burst fracture

Front 78

Bilateral facet dislocation and mechanism

Back 78

has a cervical spondylolisthesis
Mechanism: hyperflexion

Front 79

Hangmans fracture

Back 79

hyper-extension injury
bilateral pedicle fractures of C2

Front 80

Teardrop fracture?

Back 80

hyperflexion or extension
anterior inferior corner broken off

Front 81

Chance Fracture

Back 81

from lap belt injury
Flexion-distraction injury to lumbar vertebrae
transverse fracture through body and splaying of spinous processes

Front 82

Central cord injuries?

Back 82

elderly
extension injury
arms>legs affected

Front 83

Anterior cord injury?

Back 83

flexion injury
motor function impaired
pain/temp impaired
gross touch, and proprioception ok

Front 84

Brown-Sequard

Back 84

Motor and proprioception impaired ipsilateral
Pain/temp impaired contralateral