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90 Cards in this Set
- Front
- Back
Explain the pathophysiology of a concussion.
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- Complex pathophysiological process affecting the brain induced by traumatic biochemical forces.
- Caused by an impulsive force transmitted to the head. - Results in rapid onset of short-lived impairment of neurological function that resolves spontaenously. - Graded sets of clinical syndromes. |
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Does the acute clinical symptoms of a concussion reflect a functional disturbance or structural injury.
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Functional disturbance.
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What are the complications of a concussion?
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- Impaired reaction time.
- Delayed information processing. - Second impact syndrome. - Post-concussive syndrome. |
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What is the treatment for a concussion?
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- Exclude serious injury.
- Admit to hospital if: a) Focal neurological signs. b) Cerebral irritation > 1 hour. c) Deteriorating mental state. Relative indications: d) Loss of consciousness greater than 5 minutes. e) Convulsion. f) > 1 episode of moderate to severe concussion in season. |
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What are the cognitive features of a concussion?
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- Unaware of the score, period of a game, etc.
- Confusion. - Amnesia. - Loss of consciousness. - Unaware of time, date, place, etc. |
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What are the signs and symptoms of a concussion?
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- Headache.
- Dizziness. - Nausea. - Unsteadiness and poor coordination. - Poor concentration. - Unusual emotions and personality changes. - Reduced playing ability. - Visual disturbance. |
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Return to activity protocol for a possible concussion.
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- 6 step return-to-play protocol.
- Full STM & information processing. - Neuropsychological testing - DSST. |
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What are the indications for ordering a CT or MRI in a concussion?
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- Prolonged disturbance of conscious state.
- Focal neurological deficit. - Seizure activity. - Persistent clinical symptoms. |
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Preventative measures against concussion.
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- Mouth guards.
- Conditioning neck muscles. - ?Headgear. - Rule changes. |
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What percentage of spinal injuries is caused by an motor vehicle accident?
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50%.
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What percentage of spinal injuries in caused by sport?
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12%.
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What are the typical causes of spinal injury?
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- Forced flexion.
- Axial compression. - Hyperextension. - Flexion/rotation. |
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When do you start suspecting a spinal injury?
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- Nature of injury e.g. direct blow or severe deceleration.
- Pain & tenderness. - Neurological symptoms - even if transient. - Comatose or stuporose. - Associated injuries: Facial e.g. nose or jaw fracture. Head injury especially if LOC. |
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Assessment of possible spinal injury include:
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- ABC.
Initial assessment - LOC. - Motor loss. - Sensory loss. - Spinal palpation. More detailed assessment: - ABC. - BP. - Full neuro assessment, including: = Document highest normal motor level and specific movements. = Document sensory level - light touch and pinprick. = Sacral sparing - lesion incomplete. |
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When transferred to hospital, spinal injuries should have what in the way immediate management?
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- Nasogastric tube if significant defect.
- IV -- Nil by mouth. Beware of neurogenic shock. Don't overload. 80mms systolic is satisfactory. - IDC. - Oxygen. - Analgesia. - Antiemetics. - Imaging. |
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What imaging investigations should be ordered for a spinal injury?
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- Xray in collar - lateral initially including C7.
- If normal, AP & oblique. - CT scan if any evidence of fracture. |
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Extensive subconjuctival haemorrhage may indicate what?
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Retrobulbar haemorrhage and/or basal fracture.
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What possible eye injuries may involve the cornea?
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- Abrasion or erosion.
- Foreign body. |
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What possible eye injury may involve the iris?
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Hyphema.
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What possible eye injuries may involve the lens?
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- Trauma.
- Subluxation risk in Marfan's syndrome. |
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What possible vitreous injury of the eye may occur?
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- Haemorrhage.
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What kind of retinal injuries may occur?
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- Haemorrhage.
- Tears. - Detachment. |
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To avoid penetrating eye injuries, do the following:
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- Never force open lids.
- Never use local anesthetic to decrease pain. - Never instill ointments. - Never double-fold pad. - Urgent referral. |
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What kind of retinal injuries may occur?
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- Haemorrhage.
- Tears. - Detachment. |
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To avoid penetrating eye injuries, do the following:
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- Never force open lids.
- Never use local anesthetic to decrease pain. - Never instill ointments. - Never double-fold pad. - Urgent referral. |
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Direct impact to the eye can result in fracture of...
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the bony orbit.
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Fracture of the bony orbit results in double vision upon upward gaze. This is due to...
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entrapment of the inferior rectus muscle.
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With a fracture of the bony orbit, you should avoid blowing your nose. Otherwise...
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it may allow contents of the maxillary sinus to track into orbit.
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If you suspect eye injury, you need to examine the following:
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- Visual acuity.
- Visual fields. - Pupil and iris. - Evert lids. - Ocular movements. |
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Equipment used in treatment of eye injuries.
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- V.A. card.
- Penlight. - Flurosceine strips. - Eye pads. - Cottonbuds. - Irrigating solutions. |
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If a chipped or avulsed tooth cannot be found after a tooth injury, what may need to be ordered?
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Chest & abdominal x-ray.
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What happens if you get a crown fracture that exposes the dentine?
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It becomes painful and requires urgent dental referral.
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Before you refer to a dentist, what needs to be done for a tooth subluxation injury?
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Repositioning and splint.
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How do you treat a tooth avulsion?
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- Irrigate the retrieved tooth with sterile saline solution or milk.
- Reimplantation and splint if patient is conscious. |
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Clinical features of a zygoma fracture:
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- Bruising eyelid.
- Asymmetry. - Paraesthesia or numbness of the cheek. - ? teeth feel normal. |
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Clinical features of a zygoma fracture:
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- Bruising eyelid.
- Asymmetry. - Paraesthesia or numbness of the cheek. - ? teeth feel normal. |
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Orbital floor fractures can result in sensory loss to the face due to...
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infra-orbital nerve damage.
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For a possible mandibular fracture, what things do you need to examine for?
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- Check teeth for blood or displacement.
- Examine for sensory loss to lip, chin & lower teeth. - Check dental occlusion. - Feel for fracture. |
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Sensory loss to lip, chin and lower teeth from a mandibular fracture is due to...
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inferior alveolar nerve damage.
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Ear injuries
How is a haematoma of the ear treated? |
Usually requires drainage and packing for 2 weeks to prevent cauliflower ear.
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Laceration of the ear...
1. Frequently involves what type of tissue? 2. Requires what for treatment? |
1. Cartilage.
2. Oral antibiotics. |
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Ear injuries
Avulsion requires what treatment? |
- A lot will survive on the small pedicle.
- Evert edges, drain haematoma, pack & pad for 2 weeks. |
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Common nose injuries in sport.
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- Epistaxis.
- Nasal fractures. - Septal haematoma. |
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Nose injuries
What are the clinical features of a septal haematoma? |
- Increasing pain with possible fever.
- Cherry like structure occluding nasal passage. |
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Nose injuries
How do you treat a septal haematoma? |
- Evacuation of the clot with a wide bore needle or small incision followed by packing.
- Antibiotic prophylaxis to prevent septal abscess & subsequent cartilage necrosis. |
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Main causes of chest injuries in sports
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- Acceleration/deceleration.
- Compression. - High speed impact. |
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Multiple rib fractures, especially in the elderly or those with chronic lung disease, can cause serious...
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Difficulties in ventilation.
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Fracture of the first rib may be associated with...
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Aortic rupture.
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Fractures of the lower ribs may be associated with...
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Rupture of the spleen or liver.
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What is a flail chest?
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Isolated segment of ribs displaced outwardly during expiration.
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What is the treatment for flail chest?
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- Selective endotracheal intubation in patients exhibiting significant difficulties in oxygenation.
- Use of epidural narcotics or local anaesthetics is the best form of analgesia. |
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Scapular fractures are significantly associated with what complications?
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Pulmonary contusion, brachial plexus injury and arterial injury. This is why hospital admission is advisable.
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Why do most sternal fractures require no therapy?
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Because most sternal fractures are non-displaced.
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What do sternal fractures increase the incidence of?
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It slightly increases the incidence of myocardial contusion and aortic rupture.
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Costochondral injuries can cause very severe pain. What management steps are involved in treating a costochondral injury?
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Initial management is conservative with rest & local heat application.
If pain persists, local anaesthetic injections or intercostal nerve block can be used. |
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Whereabout's on the clavicle do 80% of clavicular injuries occur?
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Middle third of the clavicle. Most clavicular injuries heal without difficulty.
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Anterior & posterior sterno-clavicular dislocations can usually be reduced with...
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Closed technique and local anaesthesia.
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Tension pneumothorax is potentially fatal. How is it diagnosed?
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Recognised by diminished breath sounds with possible shift of the trachea to the contralateral side.
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Tension pneumothorax is potentially fata. How is it treated initially?
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Insertion of a 14-gauge catheter into the 2nd intercostal space in the mid-clavicular line is usually adequate initial treatment.
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How should an open pneumothorax be handled?
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It should be covered and secured on 3 sides.
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What structures are usually injured to cause a haemothorax?
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Great vessels, bronchial circulation, lung parenchyma, or intercostal vessels.
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How should fluid collections from a haemothorax be drained?
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With a large bore chest tube in the 5th intercostal space.
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An urgent thoracotomy is usually necessary for a haemothorax if...
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Initial drainage > 1500ml or continues at a rate of > 300ml/hr for 3 consecutive hours.
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Which organ is most vulnerable to abdominal injuries in football?
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Spleen.
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Which organ is most frequently damaged in boxers?
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Kidneys.
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Abdominal injuries to the pancreas are _____ but have a _____ mortality.
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Abdominal injuries to the pancreas are rare but have a high mortality.
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Hollow viscera injuries are uncommon abdominal injuries. However, fixed areas such as _____, ______, and _____ are most vulnerable.
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Hollow viscera injuries are uncommon abdominal injuries. However, fixed areas such as duodenum, 1st part of the jejunum and caecum are most vulnerable.
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In what situation is the spleen particularly vulnerable to abdominal injury?
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When enlarged, such as in lymphoma or infectious mononucleosis. Contact sports are contraindicated for 6 months after all symptoms have disappeared.
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Rupture of the spleen may be delayed and can be fatal if missed. What do you need to do if there is any suspicion of splenic injury?
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Order a CT scan.
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What management is useful for kidney damage from abdominal injuries?
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Most cases can be managed by conservative treatment including bed rest, IV fluids, antibiotics and careful observation.
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If kidney damage results in frank swelling, evidence of hypotension and increasing pain, what should be done?
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Laparotomy.
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About 50% of liver injuries are simply...
Bleeding is usually minimal and self-limiting in these causes. |
Capsular tears or superficial parenchymal lacerations.
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CT scan of the liver in sports injuries might...
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Determine the extent of the liver injury. This is often important to do as severe injury with massive bleeding requires immediate surgery.
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What should you be suspicious of with liver injuries?
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Bowel peritonitis.
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2nd and 3rd parts of the duodenum are vulnerable to contusions caused by...
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Impaction against the vertebral column. A resulting haematoma may go unrecognised until vomiting appears.
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What is required if there is suspicion of duodenal, pancreas or colon injury?
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CT scan.
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Injury to colon in blunt force trauma may go unrecognised until what complication?
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Peritonitis (so CT scan to be safe!).
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Pelvic fractures usually occur in what type of sport?
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High speed sports
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If the pelvic ring has been destroyed in a pelvic fracture, what complications may occur?
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- Ruptured bladder.
- Ruptured urethra. - Rectal injury. - Internal haemorrhage. |
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List the possible causes of acute knee pain. Include a list of NOT TO BE MISSED causes.
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- Medial meniscus tear.
- MCL sprain. - ACL rupture. - Lateral meniscus tear. - Articular cartilage injury. - PCL sprain. - Patellar dislocation. NOT TO BE MISSED: - Fractured tibial plateau. - Avulsion fracture. - Osteochondritis dissecans. - Reflex sympathetic dystrophy. |
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Steps in the examination of the knee.
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1. Observation.
- Standing, walking and supine. - Look for swelling, deformity and bruising. 2. Active movements. 3. Passive movements. 4. Palpation. 5. Special tests - Presence of effusion. - Stability tests: MCL, LCL, ACL (Lachman's, Anterior Draw, Pivot Shift), PCL. - Stability tests (McMurray's, Patellar Apprehension Test). |
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Possible investigations for knee injuries.
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- Xray.
- MRI. - Ultrasound. - Arthroscopy. - CT scan. |
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List the possible causes of shoulder pain (including a NOT TO BE MISSED list!)
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- Rotator cuff strain & tendinopathy.
- Glenohumeral dislocation. - Glenohumeral instability. - Referred pain. - Fractures. - Muscle tears. - Brachial plexus injuries. - Adhesive capsulitis. - Nerve entrapments. NOT TO BE MISSED! - Tumours. - Referred pain from diaphragm, gallbladder, perforated duodenal ulcer, cardiac & spleen. - Thoracic outlet syndrome. - Axillary vein thrombosis. |
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What structures do you need to examine for in a pelvis and groin injury?
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Bone:
- Osteitis pubis. - Stress fracture pelvis. - Stress fracture femur. Joints - Hip. - Sacroiliac joint. - Lumbar facet. Muscles: - Adductors. - Hip flexors. - "Hernia" |
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Active Movements needed to be assessed with a pelvic/groin injury.
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- Hip flexion/extension.
- Hip abduction/adduction. - Hip internal/external rotation. - Squeeze test. - Lumbar spine movements. - Abdominal flexion. - Iliopsoas flexion. |
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Passive Movements needed to be assessed with a pelvic/groin injury.
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- Hip quadrant.
- Adductor muscle stretch. - Quadriceps muscle stretch. - Psoas muscle stretch. |
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Resisted Movements needed to be assessed with a pelvic/groin injury.
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- Hip flexion.
- Hip adduction. - Abdominal flexion. - Iliopsoas flexion with adduction. |
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Structures needed to be palpated with a pelvic/groin injury.
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- Adductor muscles/tendon.
- Pubis symphysis/ramus. - Rectus abdominis. - Iliopsoas. |
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Functional movements needed to be assessed with a pelvic/groin injury.
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- Hopping.
- Sit-up. - Lunge. - Zig-zag. |
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Special tests in the examination of pelvic/groin injuries.
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- Lumbar spine.
- Sacroiliac joint. - Patrick's (FABER) test. - Thomas test. - Trendelenburg test. - Cough impulse. - Ober's test. |