Assessment (Complimentary Taster Module)

Best Answer: C .
Necrotising fasciitis is increased in IV drug users.

Correct Answer: E .
Clinical features of necrotizing fasciitis include pain out of proportion, pain proximal to the area of laceration/ cellulitis, rapid spread of erythema and necrosis and crepitus. So the correct answer is all of above.

Correct answer: C .
LRINEC score consists of readings for CRP, WCC, Hb, Na+, creatinine and glucose.

Correct answer: E .
Although CRP has high weightage (4 out of total score of 13), the predictive power of CRP for infection and prognosis is weak in patients with decompensated/advanced cirrhosis and in the intensive care setting.

Correct answer: A .
Diabetic foot complications are the most common cause of nontraumatic lower extremity amputations in the industrialized world.

Correct answer: C .
Tibialis posterior tendon dysfunction does not present as an acutely swollen foot. All of the remaining present as such.

Correct answer: A .
These devices can be applied in the pre-hospital environment.

Correct answer: A . <br>
As an SHO what are you expected to present new patients that have come to the department through the emergency take, at the trauma meeting.

Correct answer: A .<br>
Social status and mobility can have an impact on the management of a patient with a neck of femur fracture .

Correct answer: E .
When presenting patients for the trauma meeting, necrotising fasciitis patients take priority, since more serious cases get the priority.

Correct answer: B .

Pain on passive stretch is thought to be the
most sensitive finding in awake patients. Pressure of 40 mm Hg may be significant, but this is not an absolute and depends
on diastolic blood pressure .

Correct answer: C .
Fat embolism syndrome is an acute respiratory disorder caused by an inflammatory response to embolized fat globules that enter the bloodstream resulting from acute long bone fractures or intramedullary instrumentation.

Patient presents with shortness of breath within 24-72 hours post-trauma, they can appear confused, on examination, tachycardic, tachypnic and petechiae over axillary region, conjuctivae and oral mucosa.

Incidence
- 3-4% with isolated long bone trauma
- 10-15% with polytrauma

Two theories explained regarding the cause of FES.
1. Mechanical theory: Embolism caused by droplets of bone marrow fat released into venous system.
2. Biochemical theory: Lipoprotein lipase induce free fatty acid production with resultant hyperinflammatory response.

Diagnosis is made clinically with presence of hypoxemia (PaO2 < 60), CNS depression, petechial rash, and pulmonary edema.

Diagnostic criteria for FES
Major (1): Hypoxia (PaO2 < 60), CNS depression (altered mental status), petechial rash, pulmonary oedema.
Minor (4): Tachycardia, pyrexia, retina emboli, fat in urine o sputum, thrombocytopenia, decreased HCT

Treatment:
1. Mechanical ventilaton with high level of positive end expiratory pressure.
2. Fracture stabilization.

Prevention:
1. Hyperhydration with 6 pints of IVD in 24 hours for 24-72 hours post trauma.
2. Early fracture stabilization with external fixation or definitive nailing.
3. Use reamers with decreased shaft width.