Pimp Notes vol. 3

Still nailing every pimp question? Thumbs up

Over the last four years, I’ve started a small collection of questions that I repeatedly gotten pimped on by various attendings from many different services. We at QuickHits decided to empower the med student by starting a weekly post with a number of high yield questions along with some you-know-it-or-you-don’t type questions that you can impress some attendings with.

We hope this allows our readers to continue to build a thorough knowledge base. Give a shot at this week’s volume of pimp notes.
See how many you get right. Leave some comments!:

  • Most common elbow fracture in adults? In pediatrics?
  • How much fluid is needed to see a pulmonary effusion on radiograph?
  • Characteristics needed to diagnose appendicitis on abdominal ultrasound?
  • What are the types of den’s fractures?
  • What is a Segond fracture? What other injury is associated w/ Segond fractures?
  • Pediatric patient presents at birth with cyanosis that is cyclical. When baby cries, his respiratory distress resolves. Dx?
  • Four basic interventions to lower ICP?
  • Diagnosis, complications, and basic management:

    Click for larger view

CONTINUE READING FOR ANSWERS

Most common elbow fracture in adults: radial head fracture

Most common elbow fracture in peds: supracondylar fracture

Amount of fluid needed to see effusion on radiograph

  • Need 175 cc of fluid to see effusion on AP view of chest
  • Need 5 cc of fluid to see effusion on lateral view of chest

Characteristics needed to diagnose appendicitis on abdominal ultrasound?

  • >6 mm distance from wall to wall
  • hypervascular on Doppler
  • noncompressible

Types of dens fractures:

Click for larger view

What is a Segond fracture? What other injury is associated w/ Segond fractures?

  •  avulsion fracture of the knee which involves the lateral aspect of the poximal tibial plateau
  • 75% are associated w/ ACL tear –> MRI is essential in management

Pediatric patient presents at birth with cyanosis that is cyclical. When baby cries, his respiratory distress resolves. Dx? = Choanal atresia

  • Membranous/bony septum between nose and pharynx
  • Baby is blue and pinks up when stimulated and starts crying
  • Unilateral =Asymptomatic until first URI
  • Bilateral = Classic newborn presentation (turns pink when crying allowing air into lung)
  • Dx: Can’t pass catheter 3-4 cm
  • Tx: surgical repair

Four basic intervenstions to lower ICP?

  • Head elevation = increased venous outflow from head
  • Sedation = decreased metabolic demand and control of HTN
  • Intravenous mannitol = extraction of free water out of brain tissue à osmotic diuresis
  • Hyperventilation = CO2 washout à cerebral vasoconstriction

Diagnosis of hand x-ray = Scaphoid bone fracture

  • Most common bone fractured among carpals
  • Presentation = young adults following fall on outstretched hand, pain at wrist joint, **tender snuff box**,
  • Tx = wrist immobilization for all nondispalced scaphoid fractures (fractures w/ <2mm of displacement and no angulation)
    • If initial x-rays are negative in pt. with suspected fracture à immobilization w/ subsequent x-ray in 7-10 days or immediate advanced imaging (e.g. CT scan)
    • Fracture displacement tx = open reduction and internal fixation
  • Complication = Avascular necrosis of the scaphoid
    • Almost always involves proximal pole
    • The more proximal is he fracture line, the risks of avascular necrosis increase

Click here for all previous “Pimp weekly” posts

Miss anything? Forgot to include something important? Leave a comment and help us improve our knowledge base for medical students!

Advertisements
Tagged ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: