Miscellaneous

Question 1

Ellis injury classification & management

Answer 1

• Class I: fracture to enamel; smooth edge with file and discharge with dental follow-up
• Class II: fracture through enamel and dentin; do above plus apply calcium hydroxide over exposed dentin
• Class III: dental consult for pulpotomy/pulpectomy to prevent infection

Question 2

Central line placement formula

Answer 2

• RSC = RIJ - 2
• RIJ = height (cm)/10
• LSC = RIJ + 2
• LIJ = RIJ + 4

Question 3

Thrombolytic absolute contraindications

Answer 3

• prior ICH
• ischemic stroke < 3 mo
• significant head/facial trauma < 3 mo
• intracranial neoplasm or malformation
• suspected aortic dissection
• intracranial/spinal surgery < 2 mo
• active bleeding/know bleeding disorder
• severe, uncontrolled HTN
• for streptokinase: prior treatment < 6 mo

Question 4

Mechanism of action for tranexamic acid

Answer 4

Forms reversible complex that displaces plasminogen from fibrin, resulting in inhibition of fibrinolysis. Also inhibits proteolytic activity of plasmin.

Question 5

When is a gastrostomy tube considered mature?

Answer 5

4 weeks after placement

Question 6

Altitude (m) at which various illnesses occur

Answer 6

> 2,000: acute mountain sickness
3,000: high altitude cerebral edema
4,500: high altitude pulmonary edema

Question 7

Where should penile escharotomy be performed?

Answer 7

Mid-laterally to avoid injury to dorsal vein during incision

Question 8

Periapical abscess pathophysiology, presentation & management

Answer 8

• pathophysiology: erosion of pulp with bacterial overgrowth (usually associated with dental caries or nonviable teeth)
• presentation: acute pain, swelling & mild tooth elevation; exquisite sensitivity to percussion or chewing
• management: antibiotics (PCN or amoxicillin), analgesia, I&D, urgent dental follow-up for definitive management

Question 9

Alveolar osteitis pathophysiology, presentation & management

Answer 9

• pathophysiology: inflammation & local osteomyelitis 2/2 loss of healing clot s/p dental extraction
• presentation: excruciating pain 3-5 days s/p tooth extraction
• management: pack socket with iodoform gauze & eugenol oil

Question 10

Mallampati classification

Answer 10

1. Soft palate, uvula & pillars
2. Soft palate & uvula
3. Soft palate & base of uvula
4. Only hard palate

Question 11

Osmolal formula

Answer 11

2xNa + BUN/2.8 + glucose/18

If +EtOH use, add in EtOH/4.6

Gap >=10 suggests exogenous osmoles