CSTR Test 2023 Questions and Answers: Anatomy, Trauma Care, and Data Analysis, Exams of Medicine

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Name the bones of the skull Parietal x 2, Frontal, Sphenoid, ethmoid, Occipital, temporal x 2 What injury would cause Racoon eyes? Basal skull fx, Frontal fx 00:0201: What are signs of a basal skull fx? Frontal - racoon eyes, Middle Fossa - CSF leak, Posterior - battle signs What are diffuse intracranial Injuries? Concussion, shear injury, DAI, Anoxic brain injury What are focal intracranial Injuries Contusion, Epidural, Subdural, Intraparenchymal - Focal meaning in one place. What symptoms should you look for in head injuries? Confusion, combative, altered cons, obtunded, posturing Define decoritate Posturing arms folded into chest Define decerebrate Posturing with limbs extended

Where can definition of trauma patient be found? The Orange Book or American College of Surgeons: "Resources for Optimal Care of the Injured Patient" ACS inclusion criteria begins with injury codes and these three criteria?

1. Hospital admission;
2. Patient transfer via emergency medical services transport from one hospital to another hospital; or,
3. Death resulting from the traumatic injury What is the trauma registry log? The Registry Log contains a listing of each change, or update to the Registry software. It is to include the specific changes, software upgrades, and any changes that are made to the user defined fields, additions and deletions, along with the date of each event. What is data presentation format? The way that the viewer wishes to view the result of the data compiled. The format identifies how the data is to be displayed such as paper, website, dashboard, PowerPoint presentation, etc. What are types of presentation formats? Tables and graphics What are types of graphic presentation? Bar graphs, pie charts, line graphs, control charts, dashboards, spreadsheets, scatter grams, pareto chart, radar chart, tree chart What does a bar graph show? Horizontal or vertical bars proportional to the values of the data. These are used for quick comparison of information. What does a pie chart show? Show proportions of a whole or percentage of a whole. What does a line graph show? Line connecting data points in a sequential order to show a trend over time. What does a control chart show?

Used to observe performance by studying variation over time and monitors if a process is within control or out of control limits using upper and lower control lines calculated using standard deviation or sigma values with the center line representing the overall average. What does a dashboard show? A compact visual presentation of critical data, usually at a higher level, to be easily understood at a glance. What do spreadsheets show? A collection of data in columns and rows that hold the data detail -- usually produced in an "Excel" type of document. What does a scatter gram show? Displays values for two variables showing the distribution of the values. 12 What does a pareto chart show? A chart showing data from most to least frequently occurring information from left to right. These are used to clearly identify higher valued items (e.g., The highest frequency or priority for resolution). What does a radar chart show? Radar Chart - (same as spider gram) shows the relationship between multiple variables with one or more axis. What does a tree chart show? (Fishbone diagram) - used to identify all of the various issues/tasks that go into development of a single outcome. How would you present volume? Visualized by a bar chart (similar to a histogram) showing different heights depicting variance from comparative items or periods of time. How would you present a trend? A trend is a series of consecutive information/data that is all moving upward or downward as time progresses. A trend line can be overlaid onto the chart information/ data for the reader to more easily visualize if there is a trend over time. What is the process of PIPS?

recognition, assessment, and correction Who originated the National Trauma Data Bank? ACS What is the Joint Commission? It is a national organization that provides standards so that hospitals may obtain accreditation for licensure and gain the right to receive payment from Medicaid and Medicare. What created the Joint Commission? Created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association. What is benchmarking? A benchmark is a standard by which something can be measured or judged, comparing like data over time with different organizations, providers, or with a recommended or desired outcome/standard. What are filters? Filters are tools that can be used to gather data into specifically defined groups, or a single item. Filters are used to easily define, view, or calculate subgroups within a larger population How do you calculate an ICU day? ICU Day = a count of any day, or partial day, that the patient was in an ICU. For example: if the patient was admitted at 11pm on one day, and discharged at 10 am the next day, this will equal 2 (two) ICU days, since the stay included 2 (two) 24 hour days. What are the 4 steps in PI and loop closure? Identification of Issues Review of Issues Corrective Action Result Evaluation What does population analysis look at? Population age, gender, residence, nationality, etc. What does sampling look at?

The process of taking a small portion of a larger set of data to study in order to obtain a picture of the probable larger total population. What does frequency look at? The number of occurrences of a repeating similar event that is identified within a defined set of reference. Define average Average or mean is the sum of the value of all integers divided by the total number of integers Define ratio One value as compared to another, i.e., frequency of occurrence as in one in 240, e.g., 1:240. Define median The median is the integer holding the middle position in a sequential listing of numbers. The median when arranged : 9 8 7 6 5 5 5 3 2 Define mode The median is the integer holding the middle position in a sequential listing of numbers. The median when arranged : 9 8 7 6 5 5 5 3 2 Define standard deviation Standard Deviation: a measure to quantify the difference between the values in the data set. Name the anatomy of the neck Cervical vertebrae x 7, trachea, esophagus, larynx, pharynx, hyoid bone. Name the bones of the face 14 stationary bones and a lower jaw bone. Inferior nasal conchae x 2, lacrimal bones x 2, mandible, maxilla x 2, nasal bones and septum, palatine bones x 2, vomer, zygomatic bones x 2, eye, ear. Name the anatomy of the chest Thoracic spine, ribs 1-12, sternum, heart, bronchi and lungs, thoracic aorta, diaphragm, thoracic esophagus. Name the anatomy of the abdomen Liver, spleen, colon, rectum, small bowel, pancreas, kidneys, pelvis, uterus, bladder, stomach, gallbladder, retroperitoneum, abdominal aorta and other vessels. Name the anatomy of the spine

Cervical-- 7 , thoracic--12, lumbar--5, sacrum—5 (fused), coccyx (tailbone)—2, 3, or 4. Note: C1 = Atlas, C2 = Axis and has a "dens" (spike-like projection) that projects upward on which the atlas rotates. Name the parts of the vertebrae Vertebral body, spinous process, transverse process, pedicle, foramen, lamina, superior and inferior articular processes. Name the anatomy of the upper extremities Shoulder girdle with scapula and clavicle. Humerus: Median and lateral epicondyle (end of humerus), capitulum, trochlea, coronoid fossa, deltoid tuberosity, greater & lesser tubercle, head & neck. 10 Ulna: Olecranon process (elbow), coronoid process, ulnar tuberosity, styloid process (projection at the distal end of the ulna). Radius: also has a styloid process at the distal end. Hand: Carpal bones x 8 (scaphoid, locate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate), metacarpals x 5, and phalanges (proximal x 5, middle x 5, distal x 5). Joints: Acromioclavicular, carpal bones (wrist), elbow, sternoclavicular, glenohumeral, metacarpophalangeal, interphalangeal. Name the anatomy of the lower extremities Pelvic girdle Pelvis: Ilium, iliac crest, acetabulum, ischium, pubis, sacrum and sacroiliac joints. Legs: femur, patella (knee cap), tibia, fibula. Joints: Hip, knee, and ankle. Ankle Bones: Lateral malleolus, medial malleolus Foot: Tarsal bones (7), calcaneus (heel bone), talus, cuboid, navicular, first, second and third cuneiform), metatarsals, phalanges Name the layers of the skin epidermis, dermis, hypodermis What is a FAST used to determine?

Focused Assessment with Sonography for Trauma is used as an initial diagnostic tool to identify intraperitoneal or pericardial free fluid. What are CT scans used to determine? Best diagnostic tool for hemodynamically stable patients. CT Scans are used to identify free air, free fluid, identify solid organ injuries and bone/cervical abnormalities not visible on a plain film. What are MRI's used to determine? used to visualize detailed internal structures. It is especially useful in brain, spinal cord, muscles, and heart Define toxicology Toxicology can involve either a blood or urine sample. Toxicology labs tests look for levels of alcohol (BAC) or drugs that may have been used. Define chemistry Chemistry labs typically include electrolyte levels Some of the tests included in a chemistry are: sodium, potassium chloride, calcium, creatinine (blood), glucose(blood sugar), magnesium, phosphorus, etc. Define hematology Involves testing on the blood itself to determine the patient blood volumes in relation to the normal values What do blood gases measure? Arterial blood gases measure the amount of oxygen, carbon dioxide, sodium bicarbonate, base excess, etc., in the arterial blood Blood loss >20% 220 lb wt. = 1500 ml. 165 lb wt. = 1125 ml. approx 5 liters of blood in body at 75 kg Who developed the Abbreviated Injury Scale? AAAM What is the format of an AIS code 7 digits How many digits in pre dot?

6 digits The pre-dot code represents the body area of injury, the anatomical structure(s) involved, the level of injury. How manyu digits in post dot? 1 digit The single digit after the dot is called the post-dot digit or severity number. What are the AIS 6 main body regions?

1. AIS region 1 = Head/Neck
2. AIS region 2 = Face
3. AIS region 3 = Chest /Thorax
4. AIS region 4 = Abdomen - Lumbar spine
5. AIS region 5 = Extremities, shoulder and pelvic girdles
6. AIS region 6 = External including burn, hypothermia, asphyxiation, drowning, electrocution, explosion full body What are the post dot severity numbers? .1 -- Minor .2 - Moderate .3 - Serious .4 - Severe .5 - Critical .6 - Maximum (not fatal, currently untreatable) A .6 is automatically an ISS = 75, code other injuries but don't add to this highest ISS total What does the AIS severity reflect? AIS severity reflects the severity of one injury for a patient 25-40 years old with no co-morbidities and with timely appropriate care. Name the bones of the face

Inferior nasal conchae x 2, lacrimal bones x 2, mandible, maxilla x 2, nasal bones and septum, palatine bones x 2, vomer, zygomatic bones x 2, eye, ear Name the bones of the chest Thoracic spine, ribs 1-12, sternum, heart, bronchi and lungs, thoracic aorta, diaphragm, thoracic esophagus. Name the organs in the abdomen Liver, spleen, colon, rectum, small bowel, pancreas, kidneys, pelvis, uterus, bladder, stomach, gallbladder, retroperitoneum, abdominal aorta and other vessels. Name the parts of the spinal column and #'s Cervical--7, thoracic--12, lumbar--5, sacrum—5 (fused), coccyx (tailbone)—2, 3, or 4. Note: C1 = Atlas, C2 = Axis and has a "dens" (spike-like projection) that projects upward on which the atlas rotates. Name the parts of the vertebrae Vertebral body, spinous process, transverse process, pedicle, foramen, lamina, superior and inferior articular processes. Name the upper extremity bones Shoulder girdle with scapula and clavicle. Humerus, Ulna, Radius, Hand, Fingers, joints Name the bones of the hand Carpal bones x 8 (scaphoid, locate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate), metacarpals x 5, and phalanges (proximal x 5, middle x 5, distal x 5). Name the bones of the lower extremity Pelvic girdle Pelvis: Ilium, iliac crest, acetabulum, ischium, pubis, sacrum and sacroiliac joints. Legs: femur, patella (knee cap), tibia, fibula. Joints: Hip, knee, and ankle. Ankle Bones: Lateral malleolus, medial malleolus

Foot: Tarsal bones (7), calcaneus (heel bone), talus, cuboid, navicular, first, second and third cuneiform), metatarsals, phalanges. What are the 3 components to GCS? Eye, Verbal, Motor Name the 4 stages of Eye GCS 1 no eye opening 2 opens to pain 3 opens to verbal command 4 opens spontaneously Name the 5 stages of Verbal GCS 1 no verbal response 2 incomprehensible 3 inappropriate 4 confused 5 oriented Name the 6 stages of Motor GCS 1 no movement 2 move to pain, extension 3 move to pain, flexion 4 withdraw to pain 5 localize to pain 6 move on command What 5 components go into calculating Trauma Score? GCS, Systolic BP, Respiratory Rate, Capillary Refill, and Respiratory Effort. What does TRISS determine? Survivability What 3 components make up TRISS? ISS, RTS and patient's age.

What is the Z score? the z score is the statistical significance of the outcome of TRISS.. If z is more negative than −1.96, significantly more patients died than were predicted. If z exceeds +1.96, significantly more patients survived than predicted What is the w score? The w score measures the clinical significance of the outcome. The w score represents the difference between the number of patients actually surviving and the number of survivors expected per 100 patients treated. Thus, a w value of +4 indicates that 4 more patients survived per 100 patients than would have been predicted. What is OIS Organ Injury Scoring - The scale is graded 1 through 6 for each organ, 1 being least severe and 5 the most severe injury from which the patient may survive. Grade 6 injuries are by definition not salvageable. Name the 4 stages of Eye GCS pediatric 1 No eye opening. 2 Eye opening to pain. 3 Eye opening to verbal command. 4 Eyes open spontaneously. Name the 5 stages of Verbal GCS pediatric 1 No vocal response 2 Inconsolable, agitated 3 Inconsistently consolable, moaning. 4 Cries but is consolable, inappropriate interactions. 5 Smiles, oriented to sounds, follows objects, interacts. Name the 6 stages of Motor GCS pediatric 1 No motor response. 2 Extension to pain. 3 Flexion to pain. 4 Withdrawal from pain.

5 Localising pain. 6 Obeys Commands. What goes into RTS GCS+SBP+RR (first vitals in ED) What is PTS Weight, airway, sob, cans, opp pen wound, skeletal ( range - 6 to +12) What are AIS components body region, type of anatomic structure, type of anatomic structure,level, level,ais score Name AIS body regions Head Face Neck Thorax Abdomen & pelvis Spine Upper extremity Lower extremity External Name the 7 AIS severity levels Minor Moderate Serious Severe Critical Maximal (currently untreatable) What is NISS New (revised) injury severity score What is TRISS

Trauma score injury severity score What are components of TRISS Age Mechanism of injury (blunt/penetrating) RTS ISS What is M score Finding different from the norm Characterizes case mix Based on ISS What is Z score How your hospital does against others Demonstrates performance National comparison What is W score ...