Part 2 Boards Question journal/Crozer/Prism

4 most common EKG findings

" 2 Fibs and flutter" 1. Atrial Fibrillation 2. Atrial Flutter 3. Ventricular Fibrillation 4. AV block FA284

how to treat hyperkalemia

" C BIG K" Ca (stabilize membrain potential) Bicarb Insulin Glucose (those 3 (+) K back into cells Kayexelate

AML

"15:17 year olds at AML shopping for AUER RODS" t(15:17) Auer rods

what are the 4 hypersensity types: give examples of each

"ACID" type 1: anaphylactic type 2: cytotoxic (autoimmune, transfusion) type 3: immune complex (serum sickness, arthus, SLE) type 4: delayed (transplant, T cells, TB, touching contact dermatitis

abx that dont need renal dosing (7)

"ADAPT CM" Amoxicillin (good for preop bacterial endocarditis) Doxycyclin Azithromycin (avoid with liver dz) Penacillin VK Tetracycline (avoid with liver dz) Clinidamycin Metranidazole

ALL

"ALL KIDS know 12:21" <15 years, t(12:21)

Micro options that cause gas (6)

"BECKSP" Bacterodes Ecoli Clostridium Klebsiella Serrattia Pseudomonas

Cavus foot type seen in what pathologies

"CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.

Drug induced SLE (6)

"CHIPP G" Chloropromazine Hydralazine Isoniazid Procainamide Penicillamine Griseofulvin

Pes cavus surgical correction (7)

"COLE DUVRIES a mexican JAPAS washing his JAHSS in a CAVE and DWYERing it MCEVENNy saying DFWO" 1. *C*ole: Dorsiflexory wedge of naviculo*c*unefiromr and *c*uboid 2. Japas: V-osteotomy of midfoot with apex of V at navicular 3. DuVries: Dorsiflexory wedge or fusion of MTJ (CCJ,TNJ) 4. Dwyer: Lateral closing wedge or open medial wedge 5. *M*cEvenny: Dorsiflexory fusion of 1st *met-m*edial cuniform joint 6. DFWO: Dorsiflexory wedge osteotomy of 1st met or all mets "$*F*@# them all" 7.JAHSS: dorsiflexory wedge osteotomy across tarsometatarsojoints

multiple myeloma symtoms

"CRAB" hyperCalcemia Renal involvment Anemia Bone lytic lesions/Back pain, Bence jones

Thiazide drugs (4)

"Colored Water Met Indian in Thialand" Chlorothiadone Hydrocholorthiazide Metolazone Indapamide

causes of gout (7)

"D CHAMPS" -DM -Cerebral Palsy -Hereditary insensitiity to pain, Hansen Dz -Alcholism -Myelodysplasia, meninomyleocele -Poliomylitis, Peripheral neuropathy -Syphilis, spinal or peripheral n. injury, spina bifida

name 5 Causes of peripheral neuropathy (12)

"DANG THE PRIST" D iabetes A myloid N utritional (eg B12 deficiency) G uillain-Barre T oxic (eg amiodarone) H eriditary E ndocrine R ecurring (10% of G-B) A lcohol P b (lead) I diopathic S arcoid T hyroid

most common DMARDs

"ELISA Please Give Her Methotrexate" Etanercept Leflonomide Infliximib Sulfasalazine Ankarina Penicillamine Glucocorticoids, Gold salts Hydroxychloroquin Methotrexate

Flat foot surgical correction options? (13)

"EVANS is a TRANY KIDner Evans Kidner "a YOUNG LOWMAN picking COTTON drinking a MILLER is a HOKE becuase he SATtigal" Lowman cotton Hoke Miller young "SELAKOVITCH BAKING in her the FRONT of her CHAMBERS" chambers baker Selakovitch "the SILVER KOUTS is a GLIECH.. CALCulate it" Gliech Silver Koutsogiannis

Loop diuretics (4)

"Etham Bum Tor in a Loop on the Floor" Ethacrynic Bumetanide Rorsemide Furosemide

what are the benign bone tumors

"FOG MACHINES" Fibrous dysplasia Osteochondroma, osteoid osetoma Giant cell tumor Myeloma ABC Chondroblastoma Hemangioma Infections Non ossifying fibroma Enchondroma Solitary bone cyst C91

Intrinsic hemolytic normocytic anemias (6)

"G6PD looking with thier SPEREOcytosis at NOCTURNAL is KINd of SICKle. They are DEFECT?" G6PD deficiency Hereditary spherocytosis Paroxysmal nocturnal deficncy Sickle cell anemia *(crisis=infection)* Pyruvate kiase deficiency HbC defect

epipyseal tumors include (4) vs diaphysis tumors (4)

"GIANT CHON is CLEARly INTEResting" Giant cell tumors Chondroblastomas (malignant) Clear cell chondrosarcomas (malignant) Interosseus ganglions "EW we MET MULTIPLE PERI, im gonna DIE" Metastasis Ewings sarcoma periosteal osteosarcoma Multiple myleoma

hypochromic microcytic anemias

"ISALT" -Iron deficinecy -Sideroblastic anemia -Anemia of chronic disease (can also be normocytic -Lead -Thalasemia W322

Anesthesia medications main use in OR: -preop anxitiey -induction of anesthesia and pain releif -start and maintan anestheisa -maintenance of anesthesia

"MFKP" "My First Kiss Please" -preop anxitiey: Midazolam -induction and pain releif: fentanyl -indcution and maintain: Ketamine -induction and mantain: Propofol (milky)

Treatment for Congestive Heart Failure?

"MOISTDADS" Morphine Sulphate O2 (4 L/min) IV fluids (to decrease HR) Sit up (Semifowler) Tourniqet Diuretic (Lasix: 20 or 40mg) Access ins/outs, Digoxin (chronotropic vs inotropic) Serum vit K (20 or 40mg)

MI what is order of treatment (6)

"MONA BeHave" Morphine O2 Nitroglycerin Aspirin Beta blockers Heparin

O' Donoghue classification

"O D*%&# I SPRAINED my ankle" L collateral ligament injury 1. ATFL 2. ATLF + CFL 3. ATFL + CFL +PTLF

CLL/SLL

"OLD waiting for a CLL while they SMUDGE themselves" >60 years old Smudge cells

CML

"Philadelphia CML at 9:22am" Philadelphia 9:22

OKC motion for supination

"SADIP" Supination: Aduction, Inversion, plantarflexion

5 types of shock? most common?

"SCHAN" -Septic (infection) -Cardiogenic (myocardial dysfunction) -*Hypovolemic (loss of blood)* -Anaphylactic (allergic reaction) -Neurogenic (spinal cord injury)

4 drugs that cause malignant hyperthermia

"SHID" Succinylcholine (muscle relaxant) Halothane (inhaled anesthetic) Isoflurane (inhaled anesthetic) Desflurane (inhaled anesthetic)

which halothane is the only one approved for anesthesia induction? It is also best used in asthmatic pts b/c is sweet smelling

"Stevo best introducture to jackass and is sweet smelling" Sevoflurane(etheralso)

best way to describe a fracture to your attending?

"TOE LARD LAD" • Type: transverse, oblique, spiral, comminuted (stability) • Open/closed • Extra/intraarticular • Length • Angulation: saggital, frontal • Rotation: transverse • Displacement: mild, mod, severe. • Location: diaphysis, metaphysis, epiphysis • Alignment: good, poor • Direction of fx line

Flat foot surgical correction in sagittal plane (5)

"YOUG LOWMAN picking COTTON and driking a MILLER is a HOKE, 1. Lowman: (Plantarflexory TN wedge athrodesis with TAL, tibialus anterior tendon rerouted under navicular to support arch, slip of achilles tendon is attached to medial arch) 2. Cotton: Open dorsal wedge of 1st Cuneifom 3. HOKE: Plantar base wedge athrodesis of navicular, 1st and 2nd cuneiform, TAL 4. Miller: Plantar base wedge of Navicula-1st cueniform and 1st cuneiform metatarsal fusion 5. Young (keyhole): reroute anteior tibial tendon through keyhole in navicular without detatch insertion, with poserior tibial tendon advancement under navicular

Pseudomonas drugs (7)

"ZAC GIFT" Zosyn Aztreonam Cipro (oral) Gentamycin Imipenem (oral) Fortaz (ceftazidime) Timentin

hydrolized time Chromic (natural) Vicryl (braided synthetic) PDS (monofilament synthetic) Monocril (monofilament synthetic) Dexon (braided synthetic) Maxon (monofilament synthetic)

"backwards alphabet: shortest chormic, V,P,M,D, Maxon to longest" Chromic: 20 days Vicryl: 80-120 days PDS: 90 days Moncoril: 90-120 Dexon: 100-200 days Maxon: 180 days

what ar the AO principles of internal fixation? (4) what creates osteogenic properties of interal fixation?

"dont RAPE our pts" 1. Rigid internal fixation 2: Anatamical reduction 3: Preserve ST and vasculature 4: Early ROM lack of motion creates ostegenic, not compression

5 reasons why a prreop EKG is recomended

"dont be a DICCC, get an EKG" 1. DMII 2. Ishcemic cardiac disease 3. CHF 4. Creatine levels >2.0 5. Cerebrovascular disease

bone tumor more commonly found in females

"female shop at GAP" Giant cell tumor ABC Parosteal osteosarcoma

MRSA drugs (5)

"hey CLINDA get your DOG and FOX in the BAC of the VAN" clinidamycin doxyclyclin (minicyclinc) zyvox Bactrim Vanco

closed kinetic chain supination of STJ

"iC eT Tabd" inversion of Calc external rot of Tibia Ab and dorsiflexion of Talus

increasing the kVp nemonic: -shades of grey? -lenghthening? -density? -penetration? -ray beam strenght? -absorption by sourrounding tissues? -contrast? -quality of xray? -exposure time? -xray tube heat? -exposrure to pt?

"increasing kVp increases GLAD POB" increase Grey Scale (overexpose) increases Lengthening increases Asorption by tissues increases Density (overexpose) increased penetrating xray increased stronger the ray Beam LOWERS QUALITY: "V for Visualize the grey" reduces contrast lowers xray quality shorter exposure time less xray tube heat less exposure to pt W198

max dose in mg/kg for: lidocaine lidocaine w epi marcaine marcaine w epi what needs to be done to convert mg to ml (cc) which local is not given to children <12 years old?

"less more less more" 300mg 500mg 175mg 225mg (to figure out what the max ml for above just divide by what percent the drug is: lidocaine 1% max ml would be 300/10= 30ml Marcaine isn't given to kids <12 years old

ectrodactyly

"lobster claw" "cleft foot" congenital absence of 2 or more central rays affects 2nd nad 3rd most often

foreign body classifications (2)

"redneck Patyk gets a splinter" Resnick Patzakis

foot appearance in frontal plane with closed kinetic chain supination (3)

"stacking" "higher" "thinner"

Flat foot surgical correction in frontal plane (3)

"the SELAKOVICH BAKER in his CHAMBER full FRONTAL" 1. Chambers: raise posterior factet of STJ using bone graft under sinus tarsi 2. Baker: Osteotomy inferior to the STJ posterior facet with bone graft 3. Selakovich: Opening wedge osteotomy of sustetaculum tali with bone graft which restrics abnormal STJ motion 4.Kouts 5. opening wedge dwyer

what are the 3 plastazote durometers and uses

#1 plastazote (pink) 15-20 durometer, topcover for neuropathtic pts #2 plastazote (white) 35 durometer, topcover or shell for DM #3 plastazote (black) 45-65 durometer, shell material for athletes

bone scan for acute OM or septic arthritis

(+) tech and (+) gallium

bone scan for choric OM,

(+) tech and (-) gallium

bone scan for osteoarthropathy

(+) tech and (-) gallium

bone scan for stress fracture

(+) tech and (-) gallium

what about tobacco and nicotine is detremental to bone healing?

(-) bone morphogenic protines (a group of cytokines and growth factors that induce bone and cartilage formation)

bone scan for celluitis

(-) tech and (+) gallium

why are salicylates like asprin contraindicated in gout pts

(-) uric acid excretion

what is cockcroft-galt equation

(140-age) x kg weight/ (72x serum cr) x 0.85 F

Gallium-67 Citrate use (2)

(binds WBC) chronic infections (6-24 hours) tumors (24-72 hours)

Contraindications for nuclear medicine (2)

(bone scan) -Pregnancy -kidney dz

Hyperthyroidism symtoms (8)

(decreased TSH but increased total T3,T4=increases metabolic rate) heat intolerance weight loss (increased appitite) hyperactivity diarrhea increased relfexes Pretibial myexedema, proptosis, exapthalmos warm, most, fine hair Chest palpitations, arrythmias

calculate the Odds Ratio in a Case-control study or cohort? (rare diseases) In a group of 100 smokers, 40 people developed lung CA while 60 people did not. In a similar group of 100 non-smokers, lung CA developed in 10 people.

(exposed with dz/exposed without dz) / (# not exposed with dz/ # not exposed without/ dz 40/60=0.67 / 10/90=0.11 0.67/0.11= 6 smokers are 6 times as likely to develop lung CA than non smokers. In a group of 100 smokers, 40 people developed lung CA while 60 people did not. In a similar group of 100 non-smokers, lung CA developed in 10 people. The odds of a smoker developing lung CA would be 40/60=0.67, whereas the odds of a non-smoker developing lung CA would be 10/90 = 0.11. The odds ratio is then 0.67/0.11, or 6, meaning that smokers are 6 times as likely to develop lung cancer than non-smokers. An odds ratio of 1 indicates no difference between groups.

Beck Triad

(findings for cardiac tamponade) hypotension, distended neck veins, distant heart sounds

joint type in foot: Planar (3)

(gliding or plane) Lisranc, intercarpal, MTJ

Schedule II drugs (3/10)

(high abuse, no refills or verbal orders) Cocaine Methamphetamine Methadone Hydromorphone (Dilaudid) Meperidine (Demerol) Oxycodone (OxyContin) Fentanyl Dexedrine Adderall Ritalin

joint type in foot: Ginglymus (hinge)

(hinge) IPJ

A,B,C of the Sanders CT classification further describe the Posterior facet fx of cal in what direction

(lateral -> medial) - A/B divide posterior facet into equal 1/3s - C divides posterior facet from sus tali

Schedule I drugs include (6)

(no medical use, high abuse) Heroin Lysergic acid diethylamide (LSD) Marijuana (cannabis)* Methylenedioxymethamphetamine (ecstasy) Methaqualone Peyote

joint type in foot: Trochoid

(ring and pivoit) none in foot. Atlantoaxial (C1 and C2)

joint type in foot: sellar (saddle)

(saddle) CCJ

calculate accuracy

(true +) + (true -) / total population

Woods light examination colors: Red= Bright Green= Green= Gold= Accentuated hypopigmentation=

*-Red= Erythrasma* -Bright Green=Tinea Capatis (Microsporum canis) -Green= Pseudomonas -Gold= Tinea Versicolor -Accentuated hypopigmentation= Ash leaf macule (pic)

talar declination angle

*-normal is 20* -seen on lateral -flat foot is increased declination

*Answer the following for #s 1-5 muscular dystrophy's:* -trait? -issue? -onset/ death -symptoms 1.Becker muscular dystrophy 2.Emery-Dreifuss 3.Duchenne's 4.Facioscapulohumeral 5.Limb-Girdle

*1. Becker muscular dystrophy* -x linked recessive -abnormal dystrophin -age of onset 5-25, wheelchair by age 20-50 , life expectancey 40-60 yrs due to respiratory failure -pseudohypertrophy calves w/ slower progression, no IQ issues, waddling gait, lordosis, cramping with exertion *2. Emery-Dreifuss* -x linked recessive -age of onset 5-15, die due to cardiac arrythemias -stiffening of spine, upper arms, peroneals, toe walking, contracted elbows *3. Duchenne's* -x linked recessive - age of onset 2-5, wheelchair bound by 10-12yr, die around 20 due to respiratory and cardiac arrest -toe walking, difficulty climbing stairs, lordosis, waddling gait, gower sign, decreased IQ, pulmonary disorders *4. Facioscapulohumeral* (pic) -autosomal dominant -age of onset is 7-20, normal life span -foot drp, popeye arms (distal arms spared) *5.Limb-Girdle* -autosomal recessive -age of onset 10-30, variable rate of progression, falling over due to m atrophy

4 schools of jurisprudence

*1. Formalism*: law is a science *2. Realism*: law is just another name for politic *3. Positivism:* law must be confined to the written rules and regulations enacted or recognized by the government *4. Naturalism:* law must reflect eternal principles of justice and morality that exist independent of governmental recognition

3 types of *dermatophytes?* 4 subtypes of Trichophyton? most common trichophyton? which tricophyton is moccasin? vesicles?, head? foot?

*1. Microsporum*: animal source-canis, human source-audouini, soil source-gypseum. green under UV light *2. Epidermophyton* (skin and nails) *3. Tricophyton* -Tricophyton rubrum (most common foot), moccasin distribution -Tricophyton mentagrophytes (2nd most common foot, vesicles and bulla -Trichophyton tonsurans (head) -Trichopyton schoenlienii (head)

most common location for gout attack (3)

*1st MTPJ* lisfranc heel

what is normal for a Q angle measurement

*<15* >15 indicates genu valgum <10 indicates genu varum

Tx for Seborrheic dermatitis (cradle cap) (2)

*Antiseborrheic shampoo* -1% selenium sulfate suspension, zinc pyrithin (head and shoulders) -tar derivatives (T/Gell) *hydrocortisone creams*

how to fix white toe syndrome (7)

*Arterial* -place foot in dependant position -lossen bandages -twist K wire -apply heat to small of back -PT block -Remove K wire -Remove dressings consider opening

Which of the RICE therapy after fracture is most important: -Rest: decrease edema, prevent displacement -Ice: 20 min on, 20 min off. Decrease edema and pain -Compress/immobilize:maintain alignment, decrease motion, decrease edema, -Elevate: decrease edema, pain, above heart (~45 degree)

*Compress/immobilize:* most important, maintain alignment, decrease motion, decrease edema

study that measures both risk factor (alcohol abuse) and outcome (depression) at the same time. Its a snapshot in the data. its the best study type of determine prevelance.

*Cross sectional study.* (Prevelance: the number of cases (disease) divided by divided by total amount of people. in a specific amount of time.)

measues biological damage caused by radiation

*Dose equivalent* vs measres biological damaged caused by radiation to a specific part of the body(Effective dose equivalent)

Etomidate is commoly used in what medical setting/why? AE?

*ER settings* b/c its a *rapid short* acting IV anesthetic that can be used in concious sedation as well as rapid induction into general anesthesia. It is *safe in pts with comprimised myocardial contractility* and who are hemodynamically unstable as it *doesnt drop the blood pressure* AE: Adrenal suppression

measres biological damaged caused by radiation to a specific part of the body

*Effective dose equivalent* "damage effects" vs measues biological damage caused by radiation (dose equivalent)

endemic disease (3) vs pandemic disease (3) vs Epidemic disease(4)

*Endemic* disease constantly present in a speficicaly smaller grouped population -common cold -chicken pox -malaria vs *pandemic*:is a global or multiple county outbreak. -HIV/AIDS, -Flu (aisian/spanish) -SARS, vs *Epidemic* *rapid and short* spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. -meningococcal infections -black plague -yellow fever -polio

"Shepherd's Crook". "Sabre Shin".

*Femoral Bowing*- Anterior Tibial Bowing - Pagets

what is proton density? In general how does an MRI work? Define BO and what MIR is it assoicated with? T1 MRI def? -hyperintense with? (4) -referred to as? vs T2 MRI def -hyperintense with? (4) -referred to as?

*General MRI: The proton density depends on proton density within the tissue volume*- the magnetic wobble or spin of protons align when an external magnet is applied. Once allined a rradio frequency is applied which causes the protons into a higher Energy which is transmited to the image. Differing image comes from different speeds of realignment within in different tissues. *T1*: speed to realign the *static magnetic vector aka BO, * following a radio frequency excitation pulse hyperintense signal with -fat, bone marrow, nerves, lipomas (referred to as anatomic image) vs *T2*: how quickly the transverse magnitation decays over time. speed of *axial spin* returns to resting via 90 degree pulse hyperintense with water, fluid filled tumors, inflammation, blood, edema. (referred to as pathologic image) W208

HLA-B27 diseases? HLA-B27= sero neg/pos,

*HLA-B27 = RAPE B Wipped /seronegative* (Reiters disease, ankylosing spondylitis, Psoriatic arthritis, IBS, Behcet's disease Whipple's disease -seropositive=Rheumatoid arthritis.

Hyperthyroidism diseases (5) vs Hypothyroidism disease (7)

*Hyper: increased T3/T4/decreased TSH -Graves (most common) -Toxic multinodular goiter -Thyroid storm -Jod-Basedow phenomenon -Thryrotoxicosis Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens

Intensity of a beam is 100mR at a distance of 1m, what is intensity at 3m.

*Inverse Square law* Intesnity 1=distance 2^2 over Intensity 2= distance 1^2 100=3^2 over x=1^2 9 x=100 x=11.1

Turf toe classification types: which types can be closed reducible? which types rupture the intersesamoidal lig? which type is the avusion fx? which type needs ORIF because it cant be closed reduced?

*Jahss classification* type I: Dorsal dislocation of prox phalanx, met punctures plantar capsule. -Intersesamoidal *lig remains intact* -no fx. -*Cant* be close reduced becuase deformity is tight, -needs ORIF type IIA: Dorsal dislocation of prox phalanx, met punctures plantar capsule. -intersesamoidale *lig ruptured*, -sesamoids no longer remain apposed to eachother, -*able* to close reduce type IIB: Dorsal dislocation of prox phalanx, met punctures plantar capsule. -intersesamoidal *lig intact*, -transverse *avulsion fx* of one of sesamoids. -*Able* to close reduce

Lowman flatfoot correction

*Lowman: (Plantarflexory TN wedge athrodesis with TAL, tibialus anterior tendon rerouted under navicular to support arch, slip of achilles tendon is attached to medial arch)* 2. Cotton: Open dorsal wedge of 1st Cuneifom 3. HOKE: Plantar base wedge athrodesis of navicular, 1st and 2nd cuneiform, TAL 4. Miller: Plantar base wedge of Navicula-1st cueniform and 1st cuneiform metatarsal fusion 5. Young (keyhole): reroute anteior tibial tendon through keyhole in navicular without detatch insertion, with poserior tibial tendon advancement under navicular

*absorbable suture?* 1. Natural (2) 2. Synthetic -(3 monofilament), -(2 Braided)

*NATURAL* Monofilament: 1. Chromic gut (Surgigut) 2. Plain gut (Surgigut) *SYNTHETIC* Monofilament: "di, gly, gle 1. PDS (Polydioxanone) 2. Maxon (Polyglyconate) 3. Monocryl (Poliglecaprone) Braided: "gal, gly" 1. Vicryl (Polygalactin 910) 2. DEXON (Polyglycolic acid) PGA "poly*g,d* are absorbable"

Eckert and Davis: Classification

*Peronenal tendon subluxation/dislocation* 1. retinaculum seperates from fibrocartlgenous ridge (most common) 2. fibrocartlagenous ridge seperates from fibula 3. Bony avulsion off fibula

Wolf-Parkinson-White Syndrome treatment

*Procainamide* (Short PR interval (< 0.12), delta wave, Symptoms can include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope)

Ruedi and Allgower is a classification for

*Tibial plafond fracture (Pilon Fracture)* 1. articular nondisplaced 2. articular displaced 3. articular displaced, comminuted

CPRS types (2)

*Type I (RSD)* induced by ST or bone injury *Type II (causalgia)* induced by nerve injury

how to fix a blue toe problem (5)

*Venous problem* -*elevate foot* (the rest below are also used in white toe syndrome) -lossen bandage -Twist K wire -Remove K wire -Remove dressing consider opening

Parkinson: akinesia vs dyskinesia

*akinesia*: Parkinsons specifically to lack of movement, such as loss of arm swing, but is also used to mean slowing (bradykinesia) or reduction (hypokinesia) in the size of movements. Akinesia affects mainly the hands or the trunk and walking." It's caused by muscle rigidity. Often begins in the legs and neck. These muscles become very stiff. When it affects the muscles of the face the individual adopts a mask-like stare *Dyskinesia*: small involuntary movements that are like small ticks. Tardive dyskinesia (TD), estimated to occur in 30% of patients treated with neuroleptics, encompasses a broad spectrum of hyperkinesias associated with exposure to these drugs.

when are Lines of Zahn found V/Q mismatch=

*before* death due to PE (alternativing red and pink lines) helps diagnose PE: V/Q mismatch= hypoxia-->respiratory alkalosis, dysnea, chest pain, tackypnea, tacycardia, death

Drugs that should be taken up to and including the day of surgery include which of the following? (8 of the following) beta blockers and pulmonary medications angiotensin II receptor blockers aspirin and vitamin E clonidine antiiarythmics diuretics ACE inhibitors calcium channel blockers nitrates digoxin statins colestipol Niacin fibic acid derivitives cholestramine oral DM meds

*beta blockers and pulmonary medications* angiotensin II receptor blockers aspirin and vitamin E *clonidine* *antiarythmics* diuretics ACE inhibitors *calcium channel blockers* *nitrates* *digoxin* *statins* colestipol Niacin fibic acid derivitives cholestramine *oral DM meds insulin only*

preferred abx for necratizing fascitis? (3/0

*beta lacatmase inhibitor*, *clindamycin*, *MRSA drug*

Torus fracture

*compression fracture* in which one side of the cortex buckles onto itself and causes microfractures while the opposite cortex remains intact

fragile X foot type? symtoms?

*flatfoot.* genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females. Affected individuals usually have delayed development of speech and language by age 2

Retractors -Handheld: 5 -Self-retaining: 4 -Finger: 6

*handheld*: Desmarres, Hohmann, Joseph hook (double skin hook), Kleinert Kurts (single skin hook), Ribbon *Self retaining:* Beckman Eaton, Heiss, Inge (laminar spreader), Weitlaner Finger*: Army Navy, Goelet, Langenbeck, Volkmann, Ragnell, Senn

wound dressing purpose: hydrocolloid? Film? Foam? Hydrogel? Alginate?

*hydrocolloid: maintain* moist while absorbing *Film: provides moist*, no absorbing *Foam: high absorbant*, care not to dry out wound *Hydrogel: rehydrate* dry wounds *Alginate: highly absorbant* and *hemostatic*

Morton Neuroma ultrasound

*hyperchoic* (watkins and AMPLE)

lidocaine toxicity primary vs severe symtoms (3) treatment (4). (initial symtoms affect CNS before CVS)

*hypotension, bradycardia-epi, decreased respiratory rate* TREATMENT: mainatin O2, Valium , atropine, epi

When are punitive (damages exceeding simple compensation and awarded to punish the defendant) damages awarded?

*intential torts* ( Fraud, misrepresentation, slander, libel and false imprisonment)

most common location for pseudogout?

*knee (50%)* followed by ankle, wrist, shoulder

high or low kVp is best to evaluate ST

*low kVp technique* is better for evaluating soft tissue. This is why a very low kVp is required for mammography.

attachments for tibialis posterior? function of TP at contact?

*main*: tuberosity of navicular, plantar 1st cuneform. *plantar*: 2,3rd cuneform, cuboid, 2-4 met bases, *recurrent:* sustentaculum tali function of TP at contact: decelerate pronation of STJ, anterior movment of tibia, internal rotation of tiba

best view to view CC coalition and *TN coalition* on xray

*medial oblique view* and lateral views

Anteromedial portal

*medial* to TA lateral to saphenous n.v (classically the first portal made)

indication for a weil osteotomy? Orientation of the cut?

*metatarsalgia.* dorsal-distal to proximal-plantar along the metatarsal shaft, angulated 30 degrees, with an attempt to be parallel to the weightbearing surface.

define Bloodborne pathogens? (7) what are not routes of transmission? (4)

*microbugs in blood or body fluids like hepatitis and HIV*: Semen Vaginal secretions Cerebrospinal fluid Synovial fluid Pleural fluid Peritoneal fluid Amniotic fluid *(vomit, sputum, saliva (unless in dental procedure) and feces are not)*

SER fracture

*most common and most common* stage of SER 1. AITF or Tillaux-Chaput or Wagstaff fx *2. Short oblique fib fx at syndesmosis* 3. PITFL or Volkmann fracture 4. transverse fx of medial mall or Deltoid lig rup

moa for therapeutic ultrasound

*piezoelectric effect*: apply electricity to certain crystals, they vibrate generating ultrasonic sound waves

bone healing:which one is associated with AO principles of fixation? which one allows micromotion? which one is preffered method of healing. primary bone healing? vs secondary bon healing? when does vone callus form

*primary (Intramembranous) : little to no callus formation*. Preferred require anatomical reduction and rigid internal fixation, harversian healing. Cutting cone: osteoclast cutting a path follow by osteoblast laying down new bones. Gap healing: <2 mm gap still consider primary healing, No micromotion. AO prinicples of fixation. Preffered method of healing vs *secondary (enchondral) : require bone callus formation*. Allows micromotion. 8 weeks. less desirable method of bone healing.

Give an example in podiatry in which we would see contact dermatitis due to someones shoes (2)

*rubber* found in toe box of most shoes *cement* used to bind shoes together

First line of therapy for plantar wart treatment? what are its SE (list 3)

*salycyclic acid* headache, ringing in your ears, stomach pain, vomiting, diarrhea; syncope feelings; shortness of breath; burning, dryness, or irritation of the skin

when is a combo of NSAID and colchicine indicated for gout vs not

*severe attack*, >1 joint, large joint *moderate attack* monotherapy

standard of error vs standard deviation

*standard error*: estimate of how far the sample mean is from the population mean. vs Standard deviation: degree to which individuals within the sample differ from the sample mean.

common causes for erythema nodules on shins (6)

*streptococcos* most common sarcoidosis TB leprosy UC pregnancy

what are the class I steroids (4)

- *Clobetasol propionate* 0.05% (Temovate) - *Halbetasol propionate* 0.05% (Ultravate cream, ointment, lotion) - *Diflorasone diacetate* 0.05% (Psorcon ointment) - *Betamethasone dipropionate* 0.25% (Diprolene ointment, gel)

2 examples in which a dose of steroid (prednisone) would suppress the HPA axis for up to 6-12 months and prevent sx unless pt is given 50-75mg hydrocortisone the day of the surgery? what amount of prednisone *doesnt* cause long therm HPA axis supression

- 7.5 mg/day for <1week prior to sx - >20mg for > 5 days (5mg prednisone for any perior of time doesnt suppress HPA)

beir block -time limit -mmHg above systolic needed

- <45 min -30mmHg above systolic

Charnley's steps of Closed reduction:

- Exaggerate deformity - Distraction - Reducing deformity - Immobilize.

most common cuase of lisfranc injury moa

- Indirect: from forced PF. 43% - *Direct: foot trapped. 57%*

Hypothermia EKG

- J OR OSBORN WAVES (right after QRS complex & amplitude and duration are inversely related to core body temperature) this J wave is right after the QRS- it does not flatten before the T - shivering artifact - possible atrial fibrillation (look at the Osborn wave on aVF in the image)

Ottawa rule for ankle sprain or foot pain (7)

- bone tenderness: along distal 6cm pf posterior edge of fibula or tibia - fibular or tibia tip - 5th met base - navicular - midfoot -Inability to WB/walk *4* steps in ED -Inability to walk right after injury

describe bremsstrahlung (3)

- e- slow down enough to change diretion as it pass by nucleus - this causes a loss energy as x-ray. - Bremsstrahlung makes up 70% of x ray production

Fentynal characteristics: 5

- fast onset - short duration - 80-100x more potent than morphine - 40-50x more potent than heroin - used like propofol as a hypnotic agent during anesthesia

how to size up a cane? elbows flexed? which hand is it held in?

- greater trochanter to ground -30 -held on good side

Neuropraxia

- nerve contusion resulting in conduction block that recovers promptly

-DKA? -DMI or DMII? -first line of therapy?

- severe insulin deficnecy causes extreme hyperglycemia (350-900 BS) -more commonly seen in DM type I -IV fluids

-how does alcohol affect a phenol matrixectomy? -who would you neutrilize it? (2)

-*dilutes it and washes excess phenol becuase they are both in the alcohol family* (it doesnt neutrilize it). polyethyl glycerol, NaOH: 10 %, acetic acid (vinegar)

complications of a Weil osteotomy (3)

-*floating toe* most common -flail toe (reoccurance) -sausage toe (tx with sterioid to break scar tissue)

anterolateral portal

-*lateral* to peroneus tertius but usually found by transillumination

Flexible pes planus treatment from distal to proximal

-1st Cun: Cotton -nav-1st,2nd cun: HOKE with TAL -nav-1st, TN: Miller, with PTT and spring lig advance -navicular: young (keyhole) of the TA -navicular tuberosity: Kidner, TP transplantation -TN: lowman, TA rerouted to calc -Sustentaculum: selakovich restrics STJ -posterior STJ facet raised: chambers raise w/ bone -posterior STJ facet: Baker inferior -Sinus tarsi: Grice and Green -Anterior calc process: Evans -lateral calc: Silver -Calc slide up: Gleich to increase CIA -Calc slide medial: Koustsogiannis

Plastmatic Inhibition phase of graft healing

-1st phase -first 1-2 days -graft absorbs nutrients but remains *ishecemic*

Inosculation phase of graft healing

-2nd phase - by day 3 -*capillary buds* make contact with graft

Angiogenesis phase of graft healing

-3rd phase -by day 5 -new *blood vessels* grow into graft -graft becomes *vascularized*

Accomodative vs Functional use of plastazote #

-Accomodative lower durometer (#2,3) -Functional higher duromoter polypropylene, subortholene

Axonotmesis? aka? does it allow for regeneration?

-Axon damage, -aka Wallerian degeneration, -yes

braces used for Metatarsus adductus (4)

-Bebax shoe (use after serial casting) -Wheaton brace (use instead of serial casting) pic -Wheaton brace system (as additional AK component) -IPOS shoe (also used for met head ulcers), its half a shoe with proximal sole intact

glomus tumor description? derived from? location?

-Benign, painful, red-blue tumor under the nails -arteriovenous shunt surrounded by a capsule and are involved in body temperature regulation

what are the branches proximal to the sural nerve

-Communicating ramus of the LSC joines -MSC

4 main type of plates? 3 specialized plates

-Compression plate (aka dynamic compression, static compression): slopped screw holes -Neutralization plate: (-) bending, rotation, axial loading -Buttressing plate: protect from compression or axial loading -Tension-Band plate: picture 1. Antiglide plate: oblique fractures 2. Bridge plate:bridges comminution 3. Locking plates: prevent toggle

What is necrobiosis lipoidica? (4)

-Diagnosed in 50% of DM pts -Chronic granulomatous dermatitis a/w DM -Can get the lesions BEFORE onset of DM -Most frequently on shins/dorsum of foot

-what tendon is involed with Jones Tenosuspension

-EHL W388

Giant cell tumor on radiograph

-Eccentric osteolytic lesion extending to the subchondral bone, -large extensive periostitis is not present, -the cortex can be eggshell thin

contraindications for wound vac (4)

-Exposed blood vessels, organs, nerves -Malignancy -Untreated OM -Necrotic tissue eschar

Express contract vs. implied contract

-Express: uses exlicit language -Implied: without verbal use (doc implyies payment with pt)

braces used to treat club foot (4)

-Ganely splint (controls RF and FF) -Denis Browne bar (bar is screwed/rivited to shoes) -Fillauer bar (bar clamps to shoes) -Uni bar (ball n socket under foot to adjust into varus -counter rotation (Langer) (has multiple hinges to address torsion)

most common forefoot fracture

-Hallux fracture

Podiatric surgical emergencies? (5)

-Infection with emphysema (gas gangrene) -Open fracture/dislocation -Compartment syndrome -Necrotizing Fasciitis -General Neurovascular compromises

Isometric vs Isokinetic vs isotonic which ones can be performed in a cast

-Isometric contraction (static contraction): muscle contraction not associated with joint motion or change in muslce lenght. can be preformed in cast -Isokinetic contraction: Contraction at a constant velocity at all ranges of motion by using a machine with an accommodating resistance. -Isotonic contraction: muscle contraction with assoicated joint motion and change in muscel lenght. Can be preformed in a cast

what/why can be given preopertivley for thyroid surgery (2)

-Lugol solution -Saturated solution of potassium iodide They *decrease* vascularity to the gland

augmented open primary repair achilles tendon -Lynn: -Silverskoid: -Lindholm: -Bug and Boyd: -V-->Y: -Ma and Griffith:

-Lynn: plantaris is fanned out -Silverskoid: 1 strip of gastroc and twisted 180 -Linholm: multiple strips of gastroc -Bug and Boyd: strips of fascia -V-->Y: lengthen proximal, with FHL -Ma and Griffith: percutaneus bunnel type

Fibrosarcoma features?

-Lytic tumor without osteoid or chondroid matrix. -May be permeative to a fairly well-defined area of lysis. -Tend to predominate in fourth decade. (30s) -May have a bony sequestrum.

Dennis Brown bar use (3)

-Metatarsus adductus -vertical talus -club foot

Conservative treatment for tarsal tunnel syndrome (3)

-NSAIDS -local PT nerve block with corticosteroids -orthotics to control pronation

Elements of full informed consent

-Nature of the decision/procedure -Reasonable alternatives -risks, benefits, and uncertainties for above -Assessment of patient understanding -Acceptance of the intervention by the patient

Cuboid abduction angle

-Normal = 0-5 -flat foot is increased

Non-absorbable suture (5)

-Nylon , -Proline . -Ethibond. -Stainless steel least rxn, -Natural Silk Great handling, "only poly g or d ar absorbable"

OFFLOADING: -Ossur Active Offloading walker -Bledsoe Boot -IPOS shoe -Orthowedge shoe -Reverse IPOS -Clamshell or Bivalve -MABAL shoes -Healing sandale -Multi podus bot -Football dressing

-Ossur Active Offloading: octogonal cushions -Bledsoe Boot: "CAM boot" to replace TCC -IPOS shoe: wedge shoe for forefoot ulcer, 10 degrees DF, with a 4cm lift -Orthowedge shoe: wedge shoe for forefoot ulcer -Reverse IPOS: wedge shoe for heel ucer, 10 degree PF -Clamshell or Bivalve: CROW to replace TCC -MABAL shoes: fiberglass cast with padding -Healing sandale: custom accomodative made with plastizote -Multi podus boot: aka L'Nard splint -Football dressing:volume of padding

all connective tissues assicated with tendon: epitenon, endotenon, paratenon, mesotenon. should be pereseved with tenond transfers 3. surroundings entire tendon, allows tendon to slide, supplies most of blood supply 4. attaches tendon to sheath, brings blood from paratedon to tendon 1. outer covering of a tendon withint its sheath, covers multiple fasicles. most important structure in tendon repair 2. loose acelluar tissue carring blood vessels that surround individual fascicles 6. cover a bunch of m. fibers which are bundled togeter by endotenon 7. smallest portion of tendon, tropocollagen, healthy fibers are composed of type 1 collogen

-Paratenon 4. Mesotenon 1. Epitenon 2. Endotendon 6. Fasicles 7. collegen fibers

-what formula is used for burn fluid managment? -Person 70kg male with burn to 25% of body, how much fluid to give?

-Parkland formula (body weight x amount burned x 4) = 70 x 25 x 4=7,000cc give 1/2 first 8 hours, give second 1/2 16 hours

-purpose for cole procedure? -how is the osteotomy?

-Pes Cavus -Dorsiflexory wedge osteotomy through the naviculocuneiform joint and cuboid W432

Depression Subtypes (5)

-Psychotic: mood-congruent delusions -Postpartum: w/in one month after birth -Atypical: weight gain, hypersomnia -Seasonal: fall and winter depression -Double: MDE in a dysthmic patient

Pancytopenia Causes (deficiency of all three cellular components of the blood (red cells, white cells, and platelets)) (4/8)

-Radiation/toxins toulene, DDT, benzene -Drugs: Sulfa, phenytoin, carbamazepine, chloramphenicol, EtOH, chemotherapy -SLE -PNH -Infections: HIV, hepatitis, CMV, EBV -B12 and folate deficiency -Thyroid-inhibiting medications such as PTU and -methimazole

surgical treatment for Eversion sprains (3)

-Schoolfied: deltoid lig advancement -DuVries: slash deltoid lig to increase scar tissue to strenght it -Wittberger: TP tendon passed through drill hole in distal tibia and reatached to itself

pyogenic granuloma, often confused with? age? commonly seen with? symtoms?

-Severe inflammation of the nail in which a lump of red tissue grows up from the nail bed to the nail plate, *confused with nodular melonaoma* -<30 years of age -pregnancy -no pain but can cause nail bed pressure pain and bleed easliy when touched

Sudeck atrophy radiographic findings? which CPRS stage is it associated with?

-Severe, patchy osteoporosis and soft tissue swelling (hands or feet) -seen with CPRS stage II

Anaphylactoid Reaction (3)

-Similar to anaphylaxis but occurs after 1st exposure -Does not require sensitization -Reactions have a dose-related toxic idiosyncratic mechanism rather than an immunologically mediated one

what are some ways the lower extremity compensates for equinus (5)

-Subtalar joint pronation -Unlocking the midtarsal joint -knee flexion -abductory twist -genu recurvatum -early heel lift

-Tillaux fracture (Chaput-Tilleaux) -Wagstaffe fracture -Volkman-Tilleaux fracture

-Tillaux fracture: SH III fracture anterolateral of distal *tibial* epiphysis. "T in tillaux, t in tibia" (pic) SER, PAB, PER -Avulsion off anterior *fibula* (anterior tib fib ligament "f in wagstaff, f in fibula" -Avulsion of posterior *tibia* (Post tib fib lig)

-EMLA cream use? -most serious SE?

-Topical anesthetic: used in circumcision -Methemoglobinemia (reduced O2 transport)

uses for white foam wound vac (4)

-Tunneling or tracking -Overlying bone or tendon -Over skin grafts -Highly sensitive pts

Tc-99MMA use

-acess capillary bed perfusion in DM -Acess healing potensial in ischemic ulcers

Absolute contrainidcations for Asprin (5)

-active wound or lesion hemorrhage -heprin induced thrombocytopenia and thrombosis (HITT) -warfarin use in pregnancy -severe trauma to head, spinal cord, or extremities with hemmorage in past 4 weeks -spinal or epidrual anesthesia

What is the talocalcaneal angle AP? more useful for cavus or flatfoot?

-aka kites angle:angle formed by the intersection of a line bisecting the head and neck of the talus and a line running parallel with the lateral surface of the calcaneus -seen on AP xray -normal is <25 *-flatfoot is >25*

Flexible pes cavus treatment from distal to proximal (7)

-all mets: DWFO -1st met-1st Cun: Mc Elvenny-Caldwell -all tarso mets: JAHSS -Nav-Cuns and Cuboid: Cole -V apex in Nav, med 1st cun, lat is cuboid: JAPAS -MTJ (choparts): DuVries -calc: Dwyer "COLE DUVRIES a mexican JAPAS washing his JAHSS in a CAVE and DWYERing it MCEVENNy saying DFWO"

5 findings on x-ray for OA

-assymetrical jt space narrowing -subchondral cysts -osteophytes -sunchondral sclerosis -joint mice -herberdens and bouchards nodes

how to draw Engles angle? normal? adducted foot?

-bisection of 2nd cunieform to the bisection of the 2nd met -normal: 24 -adducted foot: >24

lateral deviation angle for tailors bunion? 4-5 IM angle?

-bisection of 5th met in relation to medial cortex of met shaft: normal <3, >8 is abnormal normal IM 7. >7 is abnormal

-#1 tarsal fracture is in what bone -Lateral slip of plantar fascia inserts where? -Coalitions. which more common, posterior facet of T-C or C-N bar?

-calc -5th met head -CN bar

how does a Aneurismal bone cyst appear on MRI

-calcaneus -lobulated -multiseptated mass -varying signal intensitys

-screw with wider pitch is ment for cancellous vs cortical bone. -metallic components of a stainless steel screw (3) -of the 3 components, which is the major? -max harness of martensitic stainless steel screws

-cancellous -chromium (major component), nickle, molybdenum -97 HRB

when would a second dose of antibiotic needed to be given in the OR (3)

-cases longer than 2 hours -significant blood loss -Immunocomprimised pt Mcglammary 104

who is considered high risk for latex allergy (3)

-chronic urologic conditions -spina bifida -atopic dermatitis

in malpractice case, what types of damages are awarded (2)

-compensatory damages and -possibly loss of consotorium (deprivation of the benefits of a family relationship due to injuries caused by a tortfeasor)

cause of erythrasma? it often is confused with what?

-cornybacterium minutissimum stains woods lamp "coral red" -tinea pedis W242

brace for internal rotiation deformitie (2) vs surgical options for tibial torsion

-counter rotation (Langer) -Friedman counter splint or flexosplint (addresses torsion) derotational supramalleolar tibial osteotomy vs. proximal osteotomy

mechanism of injury for liz franc (2)

-crush -Plantarflexed Abducted foot

pathophysiology of Venous Insuffienciy

-desctruction of deep valves=reversal of blood goes from deep back to superficial.muscular action is innefective, superficial valves become destroyed creating increased pressure, fibrosis, pigmentaton, ulcers

example of mechanical hemostasis include? (8)

-direct pressure, compressive dressings -vessel ligation -bone wax (inhibits bone healing) -trouniquet application -acrylates -gel foam -topical thrombin

crutch training: -elbows flexed how many degrees: -Distance from axilla and armpit: -hand grip should be: -tip of cruch shoulde be how far from foot: -ascending stairs -descending stairs

-elbows flexed how many degrees: 30 degrees -Distance from axilla and armpit: 2 fingers (6cm) -hand grip should be: level of ulnar styloid process or level of greater trochanter -tip of crutch should be how far from foot: 6 in -Ascending stairs: Lead with good leg -Descending stairs: lead with bad leg

poor turgur

-fluid loss or dehydration pinch skin for a few sec and it doesnt rebound back

full thickness skin graft -thickness -encorporation -shrinkage -pigmentation -susceptible to trauma -fail rate -cosmetic appeal

-full thickness skin graft: -epidermis, dermis, appendages -slower incorporation, -less shrinkage -better cosmetic appeal -less suseptible to trauma -higher fail rate -better cosmetic appeal

Dorsum of the foot mass along tendon sheeth that trans illuminates? MRI T2/STIR? MRI T1

-ganglion -MRIT2/STIR: typically high signal -MRI T1 low signal (pic)

normal BNP levels? (B natrietic peptide) increased in what pathology?

-hormone released w/ strong heart contracting <100 (normal) -increased like at 900 with CHF,high blood pressure. lung infections, such as pneumonia

4 benefits of warming up

-increase HR -blood flow to muscles -activates B oxidation -prepare the mind

moa for local anesthetic? and what order are sensations lost?

-it binds reversibly to sodium channels and increases threshold for depolarization. -pain, temp, touch, propioception, sk muscel tone

-snowboarders fracture location? -moa? -whats the sign

-lateral process of TALUS -Dorsiflexed and inverted -V sign is disrupted

Treatment for DVT (6)

-leg elevated 15-20 degrees - bed rest -Lovenox (1mg/kg SC q 12) -monitor PTT -Coumadin for long term (10mg loading dose) -follow pt for 3 months

what is bohler angle? what is normal? calcaneal fracture?

-measures the ankle of superior calcaneus and the posterior factets of the calc -normal: 20-40 -calcaneal fractures: decreased "B below (decreased), its also Behind the foot in location" W474

osteopetrosis radiographic (3)

-medulla is complete destroyed- all bone is cortical so very brittle -Erlenmyere flask deformity -bone with in bone appearance (pic) "aka brittle bone disease"

obligations of doctor to his insurance carrier (4)

-notify promptly when a claim is received -cooperate with adjuster and defense lawyer -appear to court -submit deposition before trial

Obesity facts preop (3)

-obesity: lower mortality post op increase risk( DM, HTN, CVD, DVT -obesity increases intubation difficulty

Hyperparathyroidism on xray Review on PTH vs Calcitonin?

-osteopenia -brown tumor: holes in bone -salt and pepper" skull -rugger-jersey spine" -sup-periosteal bone resorption PTH (+) osteoclast to destroy bone and increase blood calcium levels Calcitonin (-) osteoclasts, it brings calcium from blood into bones

How is the Babinski reflex tested? normal?

-outer surface of sole stroked with blunt object from heel toward the small toe -normal reponse is toe flexion

Early radiographic signs of gout? most common gout type?

-periarticular swelling of joint margins -erosions of joint -punched out lesions -Gout spares the joint space. *underexcreter is most common*

where are all the secondary centers of ossification in the foot? (7)

-phalanges base (6mo-2yr) -1st met base (3yr) -met heads 2-4 (3yr) -posterior calcaneus (4-10yr) -5th met tuberosity (7-10yr) -lateral tubercle of talar body (8-9) -Navicular tuberosity (10yrs)

examples of chemical hemostasis (5)

-phenol -alumnium chloride hexahydrate -silver nitrate -dichloroacetic acid -trichloroacetic acid

What is Hibb's angle? best to evaluate what? normal vs abnormal?

-plantar calc and 1st met on lateral -normal: 135-140 *-cavus foot is >150* watkins or >45

ankle arthrodiastasis: -promtes what in the jointspace -lenght of ex fix -WB? -distraction lenght -best age to perform

-proteoglycan synthesis -12 wk -yes -5mm -20s-40s

risk factors for longtitudinal meloncychia (5)

-race:Afro-Caribbeans, -trauma, -systemic disease, -medications, -postinflammatory ie lichen planus

best treatment for deep frost bite (3,4 degree) (2)

-rapid thawing at tempuraures slightly above body temp. -Immerse body part in warm water 104-107 F until it has returned to normal temp (30 min)

best treatment for superfical frost bite (frost nip) (1,2 degree) (2)

-rewarmed by applying constant warmth - gentle pressure from a warm hand (no rubbing)

why get a CHADS 2 score? what does CHADS letters represent?

-score of 5-6 justifys bridging in pts with afib who are at risk of stroke

what is talonavicular articulation? normal angle? what angle is significant for flatfoot?

-see on AP xray -normal is <50% -60%-70% head is covered indicates flat foot

What is Meary's angle? flatfoot vs cavus foot?

-seen on lateral *talus and 1st met* -normal: 0 -flatfoot: 1-15 -cavus: >15 severe

common donor sites for full thickness skin graft (4)

-sinus tarsi -gluteal fold -popliteal fossa -inguinal area -flexor cressors

location for osteoblastoma (3) is it malignant or benign?

-skull -spine -diaphysis of long bones rarley malignant, but it is a rapidly forming tumor

what causes erythema nodosum 5

-strep infection (flu) -sarcoidosis -leprocy -Innflammatory bowel disease -pregnancy

congenital vertical talus -talus: -forefoot: -calcaneus: -hallmark of vertical talus Radiographic findings: -talus and tibia -kites -talar neck shape -navicular -hubscher maneuver

-talus: vertical -forefoot: AB/DF -calc: valgus, eqin (foot may even touch front of tibia at birth) -rigidy is a hallmark Radiograph: take bil and compare it with other foot in max plantarflexed position. -talus and tibia are parallel -Kites >40 -talar possible hourglass shape or flat surface -Navicular articulates with dorsal neck of talus -Negative

-A peroneal spastic block may need to be given to more fully evaluate ththe STJ ROM of what pathology? (they are the most common cause of peroneal spastic flatfoot) -If lower STJ axis closer to floor, you get more motion in which plane?

-tarsal coalitions -frontal

Absolute Contraindications for epinephrine use in surgery (5)

-thyrotoxicosis -CAD -PVD -Vasospastic conditions -tricyclic antidepressants

-Chronic compartment syndrome symptoms -normal m. contraction can have an IM pressure >50 but should decrease after 5-10 min. If it is 30mmHg for more than_____time=compartment syndrome

-tight calf pain that occurs with heavy exercise in athletes with large mass and is slowly releived with rest -30min

Vamp of a shoe includes

-toe box -throat (area where vamp, quarter and tongue meet) (throat=vamp in pic)

-Define tort? -Define Negligence -Tort law 2 types?

-tort=Injury -Neglegence: surgeon acted unreasonably under the circumstances that resulted in pt injury. It does not impply that the neglegence was intentional or on purpose. -1. Elements of negligence tort 2.Intentional tort

tarsal tunnel causes (4)

-trauma -Inflammatory conditions -Space occuping lesions -Biomechanics

what are the types of diabetes

-type 1 10% of DM -type 2 90% of DM -gestational diabetes

most common location of pressure ulcer for: -wheelchairbound -bedridden prone -lateral position

-wheelchairbound: ischium -bedridden prone: sacrum -lateral position: trochanter

why is it advantgeous to give a local proximal to a wound (3)

-wounds are acidic -locals are weak bases -the acidicy of the wound prontaes the local outside of the cell which doesnt allow it to diffuse within the cell and be effective

Oppenheim Test? postive sign indications

. Run fingernail down along anterio-medial line of the tibia. Positive if great toe extends and toes splay and athlete has hypersensitivity. Postive sign=UMN lesion

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deep tendon reflex grading

0 = no response 1+ = diminished *2+ = NORMAL* 3+ = increased 4+ = hyperactive

Eichenholtz classification stages of Charcot

0 foot warm, no xray findings 1 fragmentation 2 coalescence 3 Remodeling

SED (ESR) rate normal? infection, inflammation, malignancy?

0-30 increased

ESR

0-30mm/hr *rate at which erythrocytes settle out of anticoagulated blood in 1 hour. Abnormal values: mild 30-40 (infection) moderate 40-70 (OM) severe 70-150 Marker for infection

time frame to justify bridging

0-6 months preop of previous Venous Thromboembolism

normal compartment pressure in foot

0-8mmHg

stages for charco (4)

0. pre charco 1. Development, acute, fragmentation 2. Coalescene, fracture healing, debri resorption, new bone formation 3. Remodeling, inflammation diminish, rocker bottom foot,

K wire sizes (5)

0.028, 0.035, 0.045, 0.054 0.062

nerve sclerosing chemical amount injected

0.5 cc 4% alcohol

incidence of DVT post op foot/ankle sx

0.5-3.5 %

How are ulcers using the UTSA graded: 0A 1A 2A 3A B C D

0A-preulcer 1A-superficial ulcer 2A-deep ulcer to tendon and capsule 3A-deep ulcer to bone and articulation B-infected C-ischemic D-both infected and ischemic W266

Determining HR by measuring the distance b/t 2 consecutive QRS complexes

1 box= 300 2 boxes= 150 3 boxes= 100 4 boxes= 75 5 boxes= 60 6 boxes= 50

How much is in 15 cube centimeters of 2% lidocaine?

1 cube centimetier (1cc) 15cc=15ml

When to give abx before surgery?

1 hour preop

Less than _______% of all energy is converted to usable x-rays. ______% is dissipated as heat: oil is used to insulate and cool the tube

1% 99%

stages of pagets (4)

1. *Destructive*: increased Osteoclastic 2. *Combinded*: bone desctruction/turnover 3. *Sclerotic/osteoblastic*: thickened trabeculae, ivory appearance in bone, bone expansion 4. *CMalignant*: elevated ALK, Ca, hydroxproline

bone healing stages (4)

1. *Inflammation:* 48 hours 2. *Soft Callus:*days to 1-2 mo-fibrous/cartilage 3. *Hard Callus:* 3-4 mo 4. *Remodeling:* years

Ex Fix types (3)

1. *Simple*: half pin + bar rail, fx must be reduced properly, tract infection 2. *Modular pin fixator* half pin and clamp and universal joint. very versatile, allow adjustment in different planes. Complex and bulky, tract infection. 3. *Ring fixator (llizarov)*: pins through bone attach to circle or half circle fixator. Allow adjustment in all planes. Bulky, pin tract infection.

1. SANDERS classifies what part of calc fractures 2. based on what CT sections 3.most common associated vertebral colunm fractured with a calc fracture?

1. *posterior facet* (CT scan-gold standard to calc evaluation) Type I - Non displaced articular fx Type II - two part posterior facet fx Type III - 3 part posterior facet fx Type IV - Four part/comminuted fx A is lateral-> B-> C is medial - A/B divide posterior facet into equal 1/3s - C divides posterior facet from sus tali 2. *coronal and axial sections* 3. *L1*

1.How far away do you need to be for sterile field? 2.About to scrub into a case. What principle must be employed? → Time/brush ? Wet/dry ? Wet/gauze ? 3.Pt with RA on corticosteroid but doesn't get dose morning of surgery, what canhappen? 4.Ending benzodiazepine? 5.Gave digital block in office and now patient with flushing, difficulty breathing, itchy, what to do? 6. Patient with history of malignant hyperthermia which inhaled anesthetic is okay foruse? 7. Of all the inhaled anesthetics, which one is most safe for cardiac pts

1. 12 inches 2. wet to dry 3. hypotensive crisis 4. anything ending in "-am", others include *Chlordiazepoxide or Clorazepate* 5. Put tourniquet around toe 6. Nitric Oxide. A pt that has malingnat hypertemia should be cooled in iced saline (not ringer's) 7. Isoflurane

where are the 3 interossei ligaments of tarsometatarsl joints

1. 2nd met base---1st cun (lisfranc) 2. 2nd met base---3rd cun 3. 4th met base---3rd cun

4-2-1 rule for maintenance fluids for an 80kg female witha 1 L deficit for 24 hours post op? 3 steps to determine rate/hr.

1. 40 + 20 + 1( weight -20) 40 + 20 + 1(80-20) 40 + 20 + 60= *120ml/hr* 2. 120 x time 120 x 24= *2880ml* 3. 2880 + ml deficit 2880 + 1000= *3880ml* 4. 3880/time 3880/24=162ml/hr

Diagnostic for OA in the knee must have 6 characterisitics?

1. >50 age 2. morning stiffness <30 min 3. bony tenderness 4. bony enlargement 5. Crepitus with AROM 6. No palpable warmth other chacteristics: synovial WBC <2000. ESR <40 rh factor < 1:50

other than routine H&P what other 3 things need to be addressed with a trauma workup

1. ABCDEs of priarmy survey 2. Tetanus status 3. NPO status

1. Acetylcysteine 2. Activated charcoal 3. Atropine 4. Digoxin immune fab 5. Dimercaprol 5. Flumazenil 6. Methylene 7. Naloxone 8. Pralidoxime

1. Acetylcysteine for acetaminophen poisoning 2. Activated charcoal for most poisons 3. Atropine for organophosphates and carbamates 4. Digoxin immune fab for digoxin toxicity 5. Dimercaprol for arsenic, gold, or inorganic mercury poisoning (MAG) 5. Flumazenil for benzodiazepine overdose 6. Methylene blue for drug-induced methemoglobinemia 7. Naloxone for opioid overdose 8. Pralidoxime for anti-cholinesterase nerve agents

what is done in a choparts amputation do preent equinovarus deformity

1. Achilles tenotomy 2. Tibialis anterior tendon reatached through drill hole in neck of talus

stages of CRPS

1. Acute/hyperemic 2. Dystrophic (sudex atrophy) (spotty osteopenia) 3. Atrophic

1. Epidemiology def 2. Incidence def? study type? 3. Prevelance def? study type

1. Branch of medical science concerned with the incidence, distribution, and control of diseases that affect large numbers of people. 2. The number of of new cases (disease) developing in a specific time in which the population is at risk. (cases/specific date) *cohort* odds ratio 3. The number of cases (disease) divided by divided by total amount of people. in a specific amount of time like weeks or months. (cases/people). *cross sectional study*

Appropiate reason s to end a pt-doc relationship (5)

1. Breakdown of trust and respect 2. Patient fraud (drug seekers) 3. Serious threat of harm, inappropriate behavior, conflict of interest 4. Communication breakdown 5. Physician's practice too large

3 common options Kuwada II treatments

1. Bunnell (figure 8 or weve stich) "nn looks like sideways 8" 2. Krackow (Interlocking stich)- strongest 3. Kessler (box sticth) "kelso likes box cars"

top factors that lead to post op Cardiac complications (4)

1. CHF 2.Rhythm 3.Age 4.coronary dz

*cavus foot radiology* angles for the following: CIA? Hibbs? Meary? kites? Cyma line? bullet hole sign? stacking mets?

1. CIA (>30) 2. Hibbs agle (>150) 3. Meary angle (>15) 4. Kites (<25) 5. posterior cyma line 6. bullet hole sign 7. stacking the mets "CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.

1.Disease: -progressive distal to proximal muscle weakness below knee -muscle atrophy -foot drop -pes cavus -affects peroneus brevis (spares peroneus longus) -lower motor neuron disease 2.Which muscle is best to be used for transfer

1. CMT 2. Tibialis posterior

prosimal phalanx HAV procedure 1. Poximal akin 2. Distal akin

1. DASA 2. corects IPJ

what is the hibbs tenosuspension

1. EDL tendon slips are ditached from insertion, combined and reattached t the 3rd cuneiform or base of 3rd met 2. the EDB tendons are reattached to each EDL tendon (this releases the buckling force at the MPJ and elevates the forefoot)

Jones Tenosuspension tendon transfer (3 steps)

1. EHL tendon is transected and rerouted at the 1st met head medial to lateral. 2. The distal stump of the EHL tendon is attached to the EHB. 3. Arthrodesis of 1st IPJ W388

Types of Bone growth stimulators (3)

1. Electrical Bone Stim (implanted 6-8 mo) "right on the BONE: invasive" 2 Electric field bone stim (non-invasive) "general FIELD of bone: non-invasive -Capacitive coupling (alternating current) -Inductive coupling (magnetic field) -Pulsed Electromagnetic Field (induced e field -Combined magnetic filed (static magnetic field) 3. Ultrasound bone stim (non-invasive)

Flat foot surgical corection in Transverse plane (2)

1. Evans: open osteotomy of calc 1.5 prox to CCJ with insertion of bone graft 2. Kidner (remove navicular tuberosity and trasnplant tibialus posterior tenond under navicular)

name the tendon associated with procedure 1. Girdlestone procedure and def 2. Jones tenosuspension and indications (2) 3. Hibbs tenosuspension and indication 4. Heyman procedure 5. Anchovy

1. FDL: cut, split, wrapped around prox phalnx 2. EHL: flexible cavus, flexible PF 1st ray 3. EDL: cut and shoved into 3rd met base or cun. Equinus w/o claw toes 4. long extensors 5. tenon is rolled up as interpositional

hammer toe deformities: (3) -what muscle is affected? -what is the deformities? -what is most common?

1. Flexor Stabilization: (flexor fire earlier and longer) "stable flexor is a pro" -PT tendon unable to resupinate the MTJ and STJ during midstance or beginning of propulsion -*Pronated foot* 2. Flexor substitution: "sub flexor ruptured surae" -least common, -seen after a rupture of triceps surae -over aggressive TAL 3. Extensor substitution: (extensor fire earlier and longer) "Ex sub lives in a CAVe" -TA is unable to dorsiflex through swing so EHL ad EDL substitute during swing phase -Cavus -claw toe (Extensor Stabilization doesnt exist "Stable Ex is an oxymoron doesnt exisit)

flat foot surgical correction in calcaneus (3)

1. Gleich: Oblique osteotomy displaced anterior to increase calcanela incliation angle 2. Silver: Lateral opening wedge with graft 3. Koutsogiannis: medial slide calcenal osteotomy

3 categories of retractors: 1. Desmarres, Hohmann, Joseph hook (double skin hook), KleinertKurts (single skin hook), Ribbon 2. Beckman Eaton, Heiss, Inge (laminar spreader), Weitlaner 3. Army Navy, Goelet, Langenbeck, Volkmann, Ragnell, Senn Function of a McGlamry elevator

1. Handheld: 2. self retraction 3. Finger releases plantar adhesions

1. acronym for HIPAA? 2. what does HIPAA do for people 3. what does OSHA stand for 4. What term is required for regulated waste containers? 5. how long does medicare require to retain medical records?

1. Health Insurance Portability and Accountability Act: 2. make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs 3. OSHA: Occupation safety & Health administration 4. biohazard 5. 6 years after creation

surgical optiosn for MA treatment of kids >2 years old after conservative serial casting has failed (7)

1. Heyman-Herndon-Strong: Transmetatarsal base capsular release and TA release 2. Berman & Gartland: crescentic osteotomy of all met base, 6 mm distal to physis. 3. Steytler & Van Der Walt procedure: oblique lateral base closing wedge all met bases 4. osteotomy (abductory closing wedge) of all met. 5. Fowler: opening wedge of medial cun with bone graft 6.Peabody muro: excision of base of 2-4, osteotomy of 5th 7. Mccormick and blount: lapidus, osteotomy of mets 2-4, wedge resection of cuboid

head bunion procedures general indications: 1. Austin: cut angle? 2. youngswick: 3. Reverdin: 4. Reverdin green: 5. Reverdin laird: 6. Reverdin Todd: 7. Watermann 8. Watermann-Green

1. IM, 60 degrees 2. Metatarsus elevatus 3. PASA, 4. PASA,Preserves sesamoid 5. PASA and IM, 6. PASA and IM , plantarflexion 7. hallux limitus 8. hallux limitus, preserve sesamoid

base HAV procedures general indications 1. Cresentic: benefit 2. Trethowan 3. Juvara 4. Loison Balacesu 5.Logroscino

1. IM, short 1st metatarsal (doesnt shorten) 2. IM Open base wedge 3. IM Closing oblique base wedge 4. IM lateral closing base wedge 5. PASA and IM (reverdin + base)

pt presents to the ED and DKA is suspected, what is the correct order of treatments in order? (4)

1. IV fluids (collect BMP) 2. Na (1L 0.9% Na over 1 hour) 3. K ( confirm K is >3 before insulin) 4. Insulin therapy

Intraosseus type implants (3) (not used much anymore. . the rest would be extraosseus type

1. LSI (Lundeen Subtalar implant) 2. STA-peg (Peg subtalar implant) 3. Future ASI (angled subtalar implant

1. How do you officially end doctor patient relationship? 2. Triad of informed consent (3) 3. Is it okay to charge people for copies of their medical records? 4. What variable includes mortality and number who have disease?

1. Letter 2. justice, jurisprudence, benevolence 3. yes 4. relative risk

what are the 3 positions to fully visualize the STJ on xray (Isherwood)

1. Medial Oblique= anterior facet 2. Medial Oblique Axial= middle facet 3. Lateral Oblique Axial=posterior facet W202

1. Moncheberg Dz: 2. Arterioslcerosis obliterans ( ASO, Artherioscerlotic Occlusive disease) 3. Thromboangiitis obliderans

1. Moncheberg Dz: benign areriosclerosis from *calcification* to medium sized arteries. doesnt decrease blood flow and is an incidental finding on xray 2. *proliferation of intima* of small vessels completley occlude lumen leading to tissue ischemia 3. *inflammatory changes to small-medium* sized veins and arteris most often caused by tobacco

Neck HAV procedures general indications 1. Peabody 2. Hohmann 3. Wislon 4. DRATO (derotational ABductory Transposi Osteoto) 5. Michell

1. Neck reverdin to avoid sesamoids 2. PASA, IM, metatarsus elevatus 3. shortens and lateral displaces 4 place met head in any FRONTAL plane 5. IM, plantarflexes, lateral displacement

what are the 2 basic theroys for charco delopement?

1. Neurotraumatic 2. Neurovascular

1. aka Marble bone disease. No separation of medullary and cortex. Erlenmeyer flask: flaredmetaphysis, bone within bone. Tarda type is benign, adult. Congenita ismalignant, peds, brittle bone, multi fx. assicuated with hypoparathyroidism from infancy. 2. Define pseudohypoparathyroidsim, common locations occur?

1. Osteopetrosis (pic) 2. low serum calcium and high phosphate, but the parathyroid hormone level (PTH) is appropriately high (due to the low level of calcium in the blood). short 4th mets

4 reasons for hallux varus complication after bunionectomy

1. Overcorrection of Bunion deformity 2. Medial capsuloraphy over tightening 3. Staking of the Head 4. Removal of Fibular sesamoid

what are the phases of graft healing? (3) same for both partial and full thickness

1. Plasmatic Inhibition phase 2. Inosculation Phase 3. Angiogenesis Phase

subtypes of Juvenile Rheumatoid arthtiris

1. Polyarticular (40%) 5 or mor jnts 2. Pauciarticular (40%) (iridocyclitis) 4 or less jnts 3. Systemic (20%) still disease

There are 3 levels of disease prevention what level if podiatry?

1. Primary Prevention - trying to prevent yourself from getting a disease. *2. Secondary Prevention - trying to detect a disease early and prevent it from getting worse.* (podiatry) 3. Tertiary Prevention - trying to improve your quality of life and reduce the symptoms of a disease you already have.

fixation order for triple (6)

1. Resect MTJ (CC then TN) to allow access to STJ 2. resect STJ 3. Temporay fixation STJ 4. Temopary fixation MTJ (CC then TN) 5. Fixate STJ 6. Fixate MTJ

high yield contraindications for use of epinephrine in surgery? (6)

1. Sever PAD 2. Severe HTN 3. Hyperthyroidism 4. Pheochromocytoma 5. Tryciclicn antidepressants (MOA inhibitors) 6. Vasospastic conditions

1. Where are STJ arthroeresis implants inserted? 2. how does it work? 3. aka

1. Sinus tarsi between posterior and middle facet 2. limit pronation and reduce heel valgus by blocking contact of lateral talar process against the calcaneal sinus tarsi floor 3. aka "implantable orthotic"

Port-Wine Stain (Nevus Flammeus) associated with what 2 syndromes

1. Sturge-Weber syndrome (pic) 2. Klippel-Trenaunay-Weber syndrome

What are semi-rigid shell materials

1. Suborthelen 2.Polypropylene 3.Orthelen 4. Carboplast

Lauge hansen PAB stage

1. Transverse fracture of medial mall (below syndesmosis) or rupture of deltoid lig 2.Rupture of anterior inferior and PITFL or Tillauex-chaput or wagstaffe frag 3. Transverse or comminuted fracture of fib at level of syndesmosis (lateral spike)

Lauge hansen PER starting stage

1. Transverse fracture of medial malleolus or rupture of deltoid ligament 2. rupture of anterior syndesmosis and rupture of interosseus membrane or Tillaux-Chaput fragment or wagstaff 3. spiral fx above level of syndes mosis, maisonneuve fx 4. posterior talofibular lig rupture or fracture of post malloelsu. large frag

triad for tetanus symtoms

1. Trismus (lockjaw) 2. Risus Sardonicus (sustained m spasm) 3. Aphagia (cant swollow)

1. cardiac catherization lab use 2. Cardiac stress testing use 3. Cardiac nuclear scanning

1. Used to evaluate the heart and blood vessels around the heart and lungs 2. Diagnose CAD. symtoms chest pain, shortness of breath....consistent with MI symtoms 3. advanced tool to diagnose CAD

Post-op Fever 5 W's, time frame, treatment

1. Wind 24-48hr: pain control, incentive spirometry 2. Water: day 3 due to urecholine, straight cath 3. Wound: day 5 4. Wonder: cany happen any time due to:Drugs anesthesia 5. Walking: day 7-10 due to not walking.

1. define tort 2. what is the inurement prohibition

1. a private not based on contracts 2. The inurement prohibition forbids the use of the income or assets of a tax-exempt organization to directly or indirectly unduly benefit an individual or other person that has a close relationship with the organization or is able to exercise significant control over the organization.

Lateral release for Bunionectomy order: (4)? which step has the risk of hallux varus?

1. adductor tendon 2. fibular sesmoidal lig 3. lateral head of FHB 4. remove fibular sesamoid (AE is hallux varus, should only be done if previous 3 steps of the release do not give adequate correction)

name the true AVNs (5)

1. capital frag of femoral epiphysis in kids 2. Talus 3. Navicular 4. Met heads 5. Sesamoids (trevors and randiers)

1. Which gives strength to wounds while healing

1. collogen

what needles when suturing skin (2)

1. conventional cutting 2. reverse cutting (pic)

Triad for haglunds deformity that can be seen on MRI t2

1. distal insertional achilles tendonopathy. 2. Retrocalcenal bursitis, 3. retro achilles bursitis

what are the elements of malpractice? (4)

1. duty 2. breach of duty 3. damage 4. causation: causal relationship b/t breach of duty and damage (proximate cause)

3 phases of technetium bone scan/ time frame

1. dynamic blood flow. 3 sec interval 2. blood pool. 3 min 3. bone imaging. 3 hours 4. delayed. 24 hours to allow for clearance)

Valmassy's rule of 7 (2) what if the kid is still everted at 7 years old?

1. early walking child should have *maximally everted calc of 7 degrees* 2. by age 7 the calc should be *perpendicular to the ground* (if kid still has max everted calc of 7 degrees= pediatric hyper mobile flatfoot)

3 types of tailor's bunion

1. enlarged head 2. increased lateral bowing angle >8 3. increased 4-5 IM angle. >7

degrees of burn? (4)

1. epidermis 2. epidermis/partial dermis 3. subcutaneus tissue (full thickness) 4: underlying muclse W493

1. mechanism of injury for distal tibiofibular syndesmotic injury (3) 2.how to clinicaly illict pain with a syndesmotic injury 3. clinica tests for syndesmotic injury (3) 4. normal tibfib overlap >10mm, Tib clearspace <5-6mm, medial clearspace <4mm should be on what type of radiograph 5. 4.5 syndesmotic screw through # corticies? is the screw removed after 4 months?

1. eversion, dorsiflexion, pronation 2. Dorsiflexion ankle as anterior portion is wider, POP to syndesmosis 3. clinical tests -External rotation test (aka Kleiger test) pain with dorsiflexion and external rotation. -Distal compression test: medial compression of malleoli -Squeeze test: (aka hopkins test): proximal compression, can also do with crossed leg test does the same thing 4. tib/fib overlap: AP, tib/fib clearspace and medial cleaspace on AP or ankle mortice 5. 4 corticies, yes

hammertoe release steps (5)

1. extensor expansion release 2 EDB, EDL tenotomy/lenghtening 3. transverse MPJ capsulotomy 4. collateral lig release 5. plantar plate release with Mc Glamry scoop

3 most common causes of HAV

1. female 2. long first met 3. oval or round first met

first, second, third step in *high energy pilon fracture* (Plafond fracture, is a fracture of the distal part of the tibia,) is to stabilize:

1. fibular fracture 2. tibial plafond 3. medial mall fracture

Order for mal practice (5)

1. filling a complaint 2. doc contactacs mal practice insurance 3. Discovery 4. Settlement 5. Trial or Arbitration

-purpose for Jones Tenosuspension procudure (2)

1. flexible cavus foot, 2. flexible plantarflexed 1st ray

#1 and #2 reason for graft failure? other reasons?

1. hematoma 2. Infection -seroma (major complication from split thickness grafts) -shearing -poor wound bed

1. pPin and SnNout 2.high specificity vs high sensitivity

1. high specificty=Rule In high sensitivity=RO 2. good diagnostic test. vs good screen test

1. cannula ankle scope 2. trocar ankle scope 3. Obturator

1. hollow tube to maintain portal and put instraments through 2.sharp rod placed in cannula to pierece ST and capsule 3. same as trocar but blunt used to penetrate the joint

Triad for fat embolism

1. hypoxia 2. neurological abnormalities 3. etechail rash

define anemia (3)

1. increased RBC desctruction 2. decreased RBC production 3. blood loss

1.clubfoot radiograph: (3) 2.Simons rule of 15s 3. Beatson and Pearson Assessment method 4. when casting for club foot position of knee, -size of cast material, -lenght of ponsetti casting, -when to consider surgical treatment

1. kites angle: decreased -CI: decreased -Talar head/neck relative to body: increased adduction and plantarflexion 2. age <3 years -> *talo-nav subluxation*: if "MEARY flys a KITE with SIMON" kites = <15 degrees. mearys angle = >15 degrees 3. if sum of CIA and Kites is <40 degrees=foot is clubbed 4. 75-90 degres, -2 inch, -till age 4 -if no improvment in 12 weeks consider surgical

joint measuring: axis, moving arm, stationary arm 1. Ankle DF/PF 2. Ankle inversion/eversion 3. STJ inversion/eversion 4. 1st MTPJ Flex/Ext

1. lateral mall, 5th met base, shaft of fibula 2. anterior ankle, shaft of 2nd met, tibial crest 3. Posterior ankle, lower 1/3 of leg, bisection of calc 4. Medial 1st met head, proximal phalanx, 1st met shaft

1. AVN of the distal tibia? 2. AVN of the proximal fibular head 3. AVN of the 1st met head

1. lewin dz 2. Ritter dz 3. assmann dz

indication for benzodiazapines (6)

1. light anesthesia conscious sedation 2. seizures 3. alcohol withdrawl 4. Parasomnias 5. anxiety disorder 6. panic disorder *Do not provide analgesia*

1. Hilgenreiner line 2. Perkin line 3. Quadrant dislocated hip 4. Acetabular angle 5. Shenton line

1. line connecting most infer portion of acetabulum 2. draw a line perpendicular to helgenreiner lign at the outer most aspect of acetabulum 3. dislocated hip shows femoral head in outside upper quadrant 4. (pic) normal 27-30 at birth and decreases by age 2. >30=dislocated hip 5. contintous semicircle with femur and acebabulum

General anesthesia has 5 components

1. loss of conciousness 2. anlagesia 3. amnesia 4. m relaxation/lack of movement 5. blunting autonomic reflexes ie HTN, tachycardia

1. greenstick fracture. 2. which side is best to put a plate

1. mainly seen in children due to soft bones concave side remains intact convex side is fractured 2. convex side W464

the tibial nerve divides into what 3 branches beneth the flexor retinaculum"

1. medial plantar n 2. lateral plantar n 3. medial calcaneal n

Capsulotomines: -which ones are both transverse and frontal plane corrections? -which one is strongest medial capsolotomi 1. mediovertical 2. medial U 3. medial H 4. Medial T 5. Inverted L 6. Washington monument 7. Lenticular

1. mediovertical 2. medial U: transverse plane correction 3. medial H: transverse plane correction 4. Medial T: transverse plane correction 5. Inverted L: transverse plane correction *6. Washington monument: frontal and transverse-strongest *7. Lenticular: frontal and transverse*

Most common tarsal coalition

1. middle facet STJ 2. CNJ 3. TNJ

Shaft HAV prodecures general indications 1. Kalish 2. Scarf 3. Ludloff 4. Mau 5. Lambrinudi

1. modified long arm austin. NO PASA correction 2. IM 3. IM (dorsal proximal to plantar distal) 4. IM (dorsal distal to plantar proximal) 5. primus elevatus with closing PF wedge

1. Tensile strength is a measure 2. Anesthesia level of consciousness for surgery

1. of the time it takes for suturing material to lose 70% to 80% of its initial strength 2. 3

expert whitness function (2)

1. opionion on proximate causation (injury related to cause) 2. opinion on standard of care

1. Positive Ortolani Sign 2. positive Barlow sign 3. Anchor sign 4. Galeazzi sign aka Allis sign 5. Abdution test 6. Nelaton line 7. Gowers sign 8. Trendelenburg sign 9. Ryders test most of dislocated hips are which side?

1. palpable click felt as femoral head is made to enter acetabulum "O for already Out" 2. dislocates an unstable hip 3. more gluteal folds on dislocated side 4. dislocated hip has a lower knee position 5. dislocated hip has limited ab of affected side 6. greater tip is palpable distal to line=dislocation (pic) 7. seen in muscular dystrophy, kids must use knees and hands to get up 8. indicates weakness in the hip abductor muscles consisting of the gluteus medius and gluteus minimus. 9. trochanteric prominence angle test and the Craig's test, is used to clinically estimate the magnitude of femoral torsion or anteversion left (60%)

Type of wound closure

1. primary-immidatley sutured, must be clean 2. secondary-infected or dirty wounds left open to allow granulation 3. delayed primary-infected or dirty wounds left open for days or weeks then later closed with sutures after infection is gone

indcation for barbituates (2)

1. rapid induction of anesthesia (30 sec) 2. treat seizures (2nd or 3rd line use though)

Steps to treat a calc fracture

1. reduce Lateral extensile incision (hockeystick) 2. anterior calc 3. reduce posterior tubercle fragment use as a joystick to get good height 4. reduce lateral fragment 5. fixatate lateral wall and fixed with screws, plates

purpose for posting on orthotic (3)

1. reduce compensation 2. matche FF to RF 3. prevent rocking

2 types of fracture blister?

1. serous/clear fluid blister with tense roof 2. hemoragic fluid blister with flaccid roof

flap phisology terms (4) 1. change in length divided by original lenght of tissue where force is applied 2. force over cross sectional area. 3. increase in strain when skin is under constant stress. occurs in minutes due to extrusion of fluid from dermis and a breakdown of dermal framework 4. decrease in stress when skin is held at tension at a constant strain for a given time. occurs over days and is due to increase skin celluarity and permanent stretching of skin components

1. strain 2. stress 3. creep 4. stress relaxation

1. In a six-month-old child, aggressive casting for the equinus component of a clubfoot deformity may result in which of the following conditions? 2. most common complication with correcting clubfoot with serial casting whcih is due to correcting the equinus before the other 3 steps 3. Why is Equinus the last step in cub foot correction?

1. subluxation of the midtarsal joint 2. rocker bottom deformtiy 3. not cause excess dorsiflexion of the forefoot causing the rocker bottom deformity

1. Ankle scope, which nerve is most likely in danger? 2.How to avoid floating toe in Weil? 3. 5 th met fracture after non-union in 26 year old college student, how do you treat? 4.Best treatment for giant cell tumor in tibia? 5. Bone graft with fully threaded screw from far to near cortex through graft too, function of screw?

1. superficial peroneal (intmediate dorsal cutaneous is most common injury) 2. plantarflex it 3. Intramedullary screw 4. Curettage and phenol 5. Buttressing

at are the types of melanoma (4)

1. superficial spreading (most common) 2. nodular (worse prognosis) 3. Letigo (face or sun exposed, freckle) 4. acral (hands and feet)

3 movment terms for ankle scope

1. sweeping: side to side, up and down 2. Pistoning: magnification 3. Triangulation:bringing scope and other instruments together for orientation

Lag technique for a 2.7 cortical bone scew

1. threadhole (underdrill, far cortex) 2.0mm= core 2. glidehole (overdrill, near cortex), 2.7mm 3.countersink 4.Measure 5.Tap 2.7mm 6.flush 7.Screw 2.7mm

2 types of metal options for screws

1. titanium 2. stainless steele

mycetoma triad? most often occurs in which climate? most common site on body? bugs? (2)

1. tumefacation (becoming swollen) 2. draining sinus 3. colonial graines in exudates tropical countires hand repeated trauma allows micro to invade 40%-eumyceoma (fungi) 60%-actinomycetes (bacteria) *not a paracytic infection*

fixation sequence (6)

1. underdrill aka thread hole, Pilot (cortex to cortex) <than screw 2. overdrill aka Glide hole: same size as screw 3. countersink: to evenly distribute the force of the head of the screw, eveny purchase the bone, avoid soft tissue irritation 4.measure 5. tap 6. scew

1. zyngodactyly 2. synpolydactyly

1. webbing of 2nd and 3rd (most common) 2. one soft tissue mass covering 4-6 toes (pic)

Posterior-Lateral portal

1.0-1.5 lateral to achilles at level of distal tip of lateral mall (sural n, lesser saphenous v, peroneal tendons all should be lateral)

minifragment screw set (3)

1.5, 2.0, 2.7 W359

options for scope size and viewing radius

1.7, 2.2, 2.7, 3.5, *4.0mm* 0-90 (*30 degrees*)

Lauge-hansen SAD stages

1.rupture of lateral collateral ligament or transverse lateral mall fracture below syndesmosis (Danis Weber A) 2. Vertical medial malleolar fx

Increased SID by a factor of 2: distance increased by 2 = ???intensity?

1/4 i=1/d^2

distance x3= intesnity

1/9

Dorsiflexion and plantarflexion required for gait

10 DF 20 PF

Antibiotic coverage length for ST

10-14 days

Inflate ankle vs thigh tourniquet to what over systoilic

100 over if ankle 200 over if thigh

hydrolization of polyglycolic acid (dexon suture)

100-200 days (4-6 months)

Low Density Lipo protein (LDL) manegment goal in pts with PAD

100mg/dL

Ankle tourniquet should be set at ______mmHg higher than systolic? Max Tourniquet time

100mmHg (Ankle tourniqet should be on less time than thigh). 90 min

average human cadence

101-122 steps per min (women have faster cadence than man)

STJ range of motion required for gait

12 degrees

Define HTN

140/90 with 2 or more readings

DP foot xray: angle and beam focus

15 or 0, 2nd met base

Fusion position for a 1st MPJ position

15-20 dorsiflexion 10-20 abduction

Fat pad normal

15-23mm

durometer measurment comparrison: lowest? highest?

15: poron 15-20: #1 plastazote 35: #2 plastazote 45-65: #3 plastazote 25-65: Dthyl Vinyl Acetate 55-60: Cork 100: Polydur

Normal Toygar's skin angle

180 decreases with achilles tendon tear

Abx treatment for Gustillo and Anderson Types 1,2,3ABC

1: Ancef 2:Ancef and Clindamycin or gentamycin 3:A,B,C Ancef, Clindamycin or gentamycin and Aminoglycoside. (add PCN to any option if there is a fear of anaerobic or if there is a soil contamination farm injury)

List the following events in order that lead to formation of HAV?

1: STJ over pronates 2: MTJ unlocks-forefoot moves lateral 3: adductor hallucis pulls hallux and sesamoids 4: base of prox phal and sesamoids move lateral 5: angular retrograde force on 1st met->met moves medial 6: adductor hallucis is taut: pulling ligaments 7: bony proliferation on met head 8: EHL and FHL now have advantage: pull hallux laterally even more

WATSON-JONES classifications

1: avultion fx of tuberoisty of navicular 2: dorsal lip fracture 3: body of navicular (runners 4-5 days pre marathon)

how many extracapsular ligaments lateral ankle

1: calcanealfibular ligament

most common type 1 rowe

1c (bifurcate lig avulsion)

1st plantar common digial br of MPn innervates

1st Lumbrical

clost kinetic chain: 1st MTPJ First ray Midtarsal joint STJ Talus Ankle joint Tibia knee femur os coxa

1st MTPJ: dorsiflexed First ray: plantarflexed Midtarsal joint: pronation, maximally pronated STJ: supination Talus: dorsiflexed and abducted Ankle joint: dorsiflexed Tibia: external rotation knee: extended femur: external rotation os coxa: higher and posterior roated

what are the heart blocks? which heart block is most likely to be fatal?

1st degree 2nd degree -Mobitz 1 aka Wenckebach (progressive lengthening of PR until dropped QRS) pic -Mobitz type II (Dropped beats without progressive lenghtoning) *3rd Degree* (complete)-lyme disese (most likely to be fatal)

PR interval is prolonged >200msec, benign and asymtomatic, no tx required

1st degree AV block

commonality of neroma locations

1st most common: Morton 2nd most common: Hauser (2nd interspace) 3rd most common: Iselin 4th most common: Heuter 5th most common: Joplin

how is lauge hansen classified

1st word position of the foot, 2nd position of talus in relation to tibia

Crevice Corrosion

2 metals move against each other

discontinue MTX preop

2 weeks

statute of limitations makes you keep radiographs for up to

2 years but most states recommend keep them for 3 years and medical records for 7 years

statue of limitations: adults vs pediatric

2 yr is the limit to file a claim. But with pediatric, there is no statue of limitation

which of the jahass classifications *can* be closed reduced

2,3

Therapeutic range fo warfarin for INR half life of warfarin? half lief of heperin and lovenox?

2-3 40 hrs (vs heperin and lovenox of 1-6 hours)

how much shortening is expected in talectomy

2-3cm

distance External fixators should be from skin

2-3cm to allow for swelling

PMMA beads Abx to cement ratio

2-4gAbx:40g cement

IDSA treatment for bone/jnt infection with *removal* of infected bone, but residual ST infection

2-4wk IV or oral:

IDSA time frame guideline for residual infection (4)

2-5 d IV or oral: bone/jnt infection *without residual infection* 2-4wk IV or oral: bone/jnt infection with removal of infected bone, *but residual ST infection* 4-6 wk IV: bone/jnt infection with *residual infected but viable bone* >3mo IV: bone/jnt infection with *residual bone infected that is necrotic*

IDSA treatment for bone/jnt infection *without residual infection*

2-5 days IV or oral

how long does bupivacaine last

2-8 hours

strenght of PMMA beads over IV abx

200x

normal metatarsal declinication angle vs normal calcalneal inclincation angle

21 vs 20-25

disarticulated met lenght

23541

how soon after technetium should gallium be given in bone scan where is gallium extreted?

24-48 hours after technitium Kidneys

head tube angulation for calcaneal axial projection

25 from vertical

if a subungal hematoma is presents what is the likleyhood of an underlying phalanx fracture

25%

If the nail involves _______% must be removed to assess for nail bed laceration

25% or more of the bed,

Medial oblique foot projection xray: angle and beam focus

25, 1st met base/cune/navicular

Axial calcaneus oblique foot xray: angle and beam focus

25, posterior dorsum of calc

Talar torsion angle

25-30

how many degrees does hip flex at contact in gait

25-35

PTT (partial thromboplastin time) vs PT (prothrombin time)

25-35 sec (monitors speed of clotting with medication use ie heparin). vs 11-13 sec (time it takes to clot) warfarin will increase PT. (increase time=increases PT)

most states require lead aprons_____mm thick

25mm

normal MCH (mass)

27-31 pg/dl

Rowe Beak fracture

2A

Rowe classification for "Beak fx vs "tongue fx"

2A: beak (posterior superior calc body) "letter A looks like a sideways beak" (pic) 2B: tongue (achillies avulsion fx) "B bite your tongue"

Rowe tongue fracture

2B

how much supinatory moment across the STJ

2mm-6mm max

When excising a neuroma, patient 4th digit is laterally deviated. What was cut?

2nd Plantar interossi deep br of lateral plantar n

EKG dx: Progressive lengthening of PR interval until a beat is dropped (a P wave not followed by a QRS complex (asymtomatic)

2nd degree AV block aka Mobitz I aka Wenkeback "going going gone"

order of fixation for lizfranc treatment?

2nd met 1st met 3rd-5th met

how to change mAs with dry plaster

2x

chopart amputation was a high risk of more proximal amputation at ____years

3

if bone needed for the OR is dropped on floor, what needs to happen to clean in

3 consecutive soaks in betadine for 15 minutes

Gustillo Anderson Type III, if a bone graft is required for repair its best done how many months after reactive bone callus has diminished

3 months

3 weeks after an injury the tensile strenght of the wound is what % range of normal skin? vs months after an injury the tensile strenght of the wound increases to % range of normal skin?

3 weeks: 20-30% months: 70-80%

Xeroform ingrediants

3% Bismuth Tribromophenate in a petroeum base

if at least _____#_____ employes are hospitalized or die, OSAHA requires this to be reported to the nearest OSHA office

3+

for every ____mm of shortentin of the first ray, there is ____mm of elevation

3, 1

estimated time frame to allow demarcation of a frost bite pt

3-5 weeks

Talonavicular coalition age group calcaneal navicular bar age group Talocalcaneal coalition age group -most common? -extra articular? -Cowell procedure is indicatied for which? -least common? -most asymtomatic? -which coaltion has an absence of CC joint?

3-5 yrs "TN is simply 3-5" *least common* *most asymtomatic* 8-12 yrs "cn kind of looks like a sidways 8" *extra articular* *codwell procedure*: placing EDB muslce belly in void of resected coalition 12-16 yrs "TC is complicatied 12-14 *most common* (pic) CC coaltion has absence of CC joint

coalitions age: 3-5? 8-10? 12-14?

3-5: Talonavicular (TN) "TN is simply 3-5" 8-10: Calcanealnavicular (CN) "sideways figure 8" 12-14: Talocalcaneal (TC) "TC is complicatied 12-14"

1 MET=

3.5 ml O2/kg/min

normal MCHC (concentration of Hb of packed RBC)

32-36 g/dl

articulated met lenght

32145

what is a "LAST" refering to shoes

3D modle of shape and cubial content of shoes that shoe is built around

CT: Voxel: 3D vs 2D box= slice thickness of

3D: 0.15-2 cm. vs 2D 0.15-0.3cm

Between what layers does the DTML lie?

3rd and 4th layer (6) Interossei (7) DTML (12) lumbrical

lyme disease and heart block relation

3rd degree (complete)

pts able to walk a flight of steps w/o SOB are considered what MET

4 MET functional capacity

IDSA treatment for bone/jnt infection with *residual infected but viable bone*

4-6 wk IV

when to treat Metatarsus adductus surgically? soft tissue surcigal corrections for MA (4)

4-6 years of age (after failed conservative) Heyman, herndon, and strong thompson procedure lange lichtblau

Glasgow Coma Scale 3 categories and sub categories

4. eye opening: none, stim, verbal, open 5. verbal response: none, imcomp, innap, confuse, normal 6. motor response: none, decerebrate, decorticate, withdraw, localize, normal <7 poor prognosis >13 good prognosis

toxic dose of lidocain per kg

4.5 so a 70kg person was a lidocaine toxic dose of: 70 x 4.5= 315

large fragment screw set (2)

4.5, 6.5

Harris beath foot xray: angle and beam focus? where is the posterior facet in relation to the middle facet?

40 or parallel to posterior and middle facet.

Lateral oblique foot xray projection: angle and beam focus

40, 4th met-cuboid articulation or 3rd met-cun

minimum pressure recommended for compression stockings for treatment of lymphadema

40mmHg

whole blood shelf life

42 days (6 weeks)

what makes up the 4th ray of the foot? what makes up the 5th ray of the foot?

4th and 5th mets with thier respective phalangy

most common location for brachymetatarsaia

4th met

If the 3rd Lumbrical was cut on a right foot how would which toe deviate?

4th toe would flex

Decrease SID by a factor of 2 (distance decreased 1/2)

4x intensity

discontinue NSAIDS preop

5 days

Clark cancer staging

5 stages"clark explores layers" layers of skin 1 epidermis only 2. dermis/papilary dermis 3. entire pappilary dermis 4. reticular dermis 5. fat

-History of 8 weeks ago inversion ankle sprain, pain with walking and pushing off,which structure was hurt?

5 th met base injury

ossification of calcaneus

5-6 mo fetal development

Oral Vitamin K comes in what size tablets in the United states?

5-mmg (most common form of vit K is oral)

Steinmann Pin sizes

5/64, 7/64, 9/64 3/32, 5/32 1/8 3/16

m/c synotosis

5th DIPJ

4 most common coalitions in order

5th DIPJ STJ CNJ TNJ

time frame for the arthritis part of reactive arthritis? most common age and sex?

6 weeks, 25-35years old male.

# angiosomes in foot, fed by which 3 a? what is a choke vessel

6, anterior tib. posterior tib. peroneal a., unify network angiosome borders with blood.

how many hours should a pre op be NPO status

6-12

>20mg of corticosteroid therapy for >5 days can affect the HPA for how long? treatment for day of surgery

6-12 months 100mg hydrocortisone or double regular dose. day of surgery.

ossification of talus

6-7 mo fetal development

when is an open fracture considered infected?

6-8 hours post injury if no treatment is started

Normal IM angle for 4th and 5th vs normal lateral bowing of angle of 5th

6.4-9.1 vs 2.64

1/2 life for T-99

6.5 hours

degree of z plasty for most lengthening? difference between a hauser and White TAL

60 hauser: section post 2/3, prox/medial 2/3 white: sectio anter 2/3, distal/medial 2/3

% of pts that have dermatological psoriasis also get psoriatic arthritis

7%

how long does it take for the entire platelet pool to be replaced

7-10 days

whats the elution rate of typical antibiotic beads

72 hours

1/2 life for gallium

78 hours

NPO status preop

8 hours NPO allowed clear liquids 2-4 hours preop

when to stop smoking preop

8 weeks preop (more advantagous than not stopping or stopping <8 weeks preop

normal Ca value

8-10

normal MCV (volume of 1 RBC)

80-100

most commonly concentation of phenol used in matrixectomy

89%

probing to bone has what % positive predictive probability of OM

89%

treatment for Met addcutus manipulation and serial casting age? ST procedures age? osseous procedures age?

8mo 4-6 >8

Lateral foot xray: angle and beam focus

90, 3-5 met base

Lateral ankle xray: angle and beam focus

90, lateral mall

AP ankle xray: angle and beam focus

90, talar dome

compression therapy is contraindicated with ABI <? also what is the minimum pressure used to treat lymphadema?

<0.8. 40mmHg

ASA Class II (7)

<1 year old >70 year old mild obesity pregnant controlled HTN controllled DM asthma smoking wo COPD anemia

functional hallux limitus is defined by several authors as when comparing CKC and OCK:

<12 degrees hallux DF: CKC >50 degrees hallux DF: OKC

% of body covered by contact dermatitis to Rx an topical vs oral

<20% topical vs >20% oral

normal lab value for cholesterol

<200 mg% W326

medial clear space normal

<4mm

Tib fib clear space vs Tib fib overlap

<6mm clear space (most accurate to determin diastasis) >6mm overlap

when to transfuse due to Hgb (2)

<7 or if drops by 2

1 rad at 12 inches=

=.25 at 24 inches

"DIAL a PIMP" helps with what injury? which is more common? which is a deep cup shaped, less likely to displace?

=location of talar dome lesions - DIAL: Dorsiflexion Internal rotation = Anterior Lateral lesion, -Lateral Lesions: (DIAL, 44% ) Thin "disc", wafer shaped, easily displaced. -PIMP: Plantarflexion Inversion = Medial Posterior lesion (Medial Lesions: (PIMP, 56%) Deep, cup shaped, less likely to displace. "PIMPS are more common, go deep, and like cupped chicks")

when to delay surgery for HTN? must wait until BP is __________ to proceed with Sx

> 200/120 must wait until BP is <180/110

DKA has what aniongap range? what blood chemisty?

>12, metabolic acidosis

threshold of blood sugar that negatively effects wound healing

>250

IDSA treatment for bone/jnt infection with *residual bone infected that is necrotic*

>3mo IV:

Brain Natiuetic Peptide (BNP) levles gold standard to dx?

>500. Heart failure

which organ is damaged if you don't immediately do fasciotomy in compartment syndrome?

??????Kidney, heart, liver or brain?????

causes of AVN "ASEPTIC G"

A - Alcoholism S - Sickle cell disease and Surgery E - Exogenous and Endogenous steroids P - Pancreatitis and Pregnancy T - Trauma I - Idiopathic C - Collagen vascular disease or Caisson's disease G- Gout

irregulary irregular, no discrete P waves sawtooth no identifiable waves

A Fib (" AFi" A fib Irregulary irregular): chaotic and erratic baseline *(irregulary irregular)* with *no discrete P* waves in between irregulary spaced QRS complexes A flutter "A flutter sawtooth): A rapid succession of identical, back to back atrial depolarization waves creating *Sawtooth" appearance* V fib "V Fib is eratic": A completely erratic rythm with *no identifiable waves*

Arthrogryposis

A child born with joint contractures.

Wimberger's ring sign

A circular, opaque radiologic shadow surroundsing epiphyseal centers of ossification in patients with scurvy.

AO pilon fracture classification A-C? 1-3?

A extraarticular B partial articular C articular 1. simple 2. comminuted metaphysis 3. comminuted metaphysis/epipysis

Leomyoma? 3 types

A fibrous, benign tumor of the uterus that usually arises from the myometrium. 3 types: 1. angioleiomyoma: vascular 2. Pilar leiomyoma: arrector pili m. 3. leomyosarcoma: GI and female genital

nerve fiber: size vs mylination A B C

A largest, mylinated B moderate, mylinated C small, unmylinated

PPD test 5mm, 10mm, 15mm of induration means what?

A positive test only tells that a person has been infected with TB bacteria, it does not tell whether the person has latent TB infection or has progressed to TB disease. <15mm=negative test TST reaction of 15mm or more of induration is considered positive in persons with no known risk factors

Trephine

A trephine is a surgical instrument with a cylindrical blade

A. max dose in ml of Bupivacaine 0.25% in a 40kg person? B. toxic ml dose of 0.25% bupivacaine? C. Toxic ml dose of 0.5% bupivacaine?

A. 40kg x 2mg/kg = 80mg / (0.25 x 10)= 80mg/2.5= 32 (must use the 4723 when determining max dose with weight of individual) B. 175mg is max/ (0.25 x 10)= 175/2.5= 70 C. 175mg is max/ (0.5 x 10)= 175/5= 35

nerve fiber function? Which is blocked first? A: -alpha -beta -gamma -delta B C

A: mylinated -alpha: motor -beta: sensory touch and pressure -gamma: propioception. -delta: temperature B-sympathetic tone (also mylinated but smaller than A) C-*dull pain*, temperature, touch, post ganglionic sympathetics (smallest, unmylinated and (1st) to be affected by local)

what are the subtypes of gustilo anderson IIIA,B,C

A: no periosteal stripping B: Periosteal stripping C: vascular comprimise

Benign blood filled cyst, not a true neoplasm, secondary to vascular injury. rapidly grows, painful, Xray: expansive lesion, bubble appearance, soap bubble appearance MRI: hyperintense, lobulated

ABC

ABC vs UBC

ABC Large medullary expansible blowout lucency • Tibia • About to the growth plate • Cortical margins are really messed up • The lesion is wider than the growth plate UBC is non expansitile, may have a fallen fragment sign central, asymptomatic, fallen fragment sign, Calcaneus. "camels are chill as they walk on hees) UBC will not grow wider than growth plate; ABC can expand wider than growth plate and extend into soft tissue

Lateral plantar n prior to division innervates

ABDm QP

Medial plantar n prior to devision innervates

ABH FDB

Gold standard to Dx PAD

ABI

first line of tx for congestive heart failure

ACE inhibitors Loop diuretics

What are reportable diseases same for each state? (6)

AIDS, HIV, syphillis, gonorrhea, chlamydia, chancroid.

Tillaux-Chaput Fracture

AITFL avulsion fx of anterolateral tibia

positive silverskiold

AJ 0 degree with knee straight AJ 10 degrees with knee flexed

Jahss classification: Type 1 and Type 2A,B? aka _____injury? Treatment for each? which one *cant* be closed reduced? which one has the sesamoid lig ruptured? which one is an avulsion off one of the sesamoids?

AKA turftoe injury *Type 1 (CANT CR* due to ST damage) (dorsal dislocation with intact sesmoidal ligament, no fx). -Tx is ORIF reduction Type 2A: Intersesmoid *lig ruptured*, sesmoids are not opposed to eachother Tx: close reduction Type 2B: Intersesmoid lig intact, avulsion fx of one of the sesamoids Tx: close reduction

-disease of mixed UML and LMN resulting in m. weakness -mental stats perserved -males 2x more than females -onset in 40s -death due to respiratory failure 3-5 years after onset

ALS

mixed UNL ad LNL disease

ALS

AP xray normal to rule out liz franc injury

AP: mets and cuns line up

match sounds to its correct murmu: decreshendo high pitch Low pitched and louder on inspiration low pitched and rumbling: high opening snap creshendo decreshendo louder on inspiration holosytolic, constant intensity, blowing increases with inspiration

ARMS PRTS (diastolic) diastolic -Aortic Regurge: decreshendo high pitch -Pulmonic Regurge: Low pitched and louder on inspiration -Mitral Stenosis: low pitched and rumbling: high pitched opening snap -Tricuspid stenosis Systolic -Aortic stenosis: creshendo decreshendo -Pulmonic stenosis: louder on inspiration -Mitral Regurge: Holosystolic, constant intensity, blowing -Tricuspid Regurge: increases on inspiration

ASA class (American Society of Anesthiologists), ASA1: ASA2: ASA3: ASA4: ASA5: ASA6:

ASA 1: normal healthy ASA2: mild systemic disease (controlled DM, prego, or obese, person with asthma ASA3: severe systemic disease or History of MI ASA4: severe systemic disease=constant threat to life ASA5: not expected to live w/o operation ASA6: brain dead, harvest organs

true LLD

ASIS to medial malleolus >0.5cm is significant ONLY VALID MEASURE is X-RAY !!!!!

Liver lab that also assess cardicac (2)

AST (8-20) >=liver and MI. < in pregno, uncontrolled DMII vs >ALT liver (0-35)

Anterior Drawer tests

ATFL >10 mm anterior translation (ATFL only)

how does an partial ATFL tear and dislocated peroneal longus tendon look on MRI. Reason for peroneal tear at cuboid notch and at troclea of calc?

ATFL: (yellow arrowheads) is mildly attenuated and irregular from a remote partial tear. (avascular areas) PL: big red arrow The posterior talofibular ligament (yellow arrow) is intact. A single peroneal tendon (red arrowhead) is seen posterior to the lateral malleolus and the second peroneal tendon (red arrow) is dislocated lateral to the fibula. The peroneus brevis myotendinous junction is visible on the upper image (red arrowhead, 2b). The superior peroneal retinaculum (green arrowheads) is laterally displaced from its normal attachment at the lateral margin of the lateral malleolus, remaining attached to the fibular periosteum (blue arrowheads) which is stripped and elevated by the dislocated tendon. The stripped periosteum forms a false pouch into which the peroneus longus is displaced

"silver dollar sign"

AVN of Navicular "NAVI spend you DOLLAR at KOLEs"

lateral release during bunionectomy carries the risk of

AVN of capital fragment due cutting the nutrient artery in the frist interspace

Insufficient fx

Abnormal bone, normal stress

amount of energy that is absorbed in matter when radiation passes through it

Absorbed dose

Thompson Test vs Homan's sign vs Silverskoid test

Achilles tear "T for Tear and Thompson" DVT (pain with DF) gastrocnemius Equinus

Thompson test

Achilles tendon rupture "Thompson Test Tear"

increased leukocytes=left shift: acute infection vs chonic infection

Acute infection

Heat Therapy contraindications

Acute injuries Imapaired circulation Poor thermal regulation areas of decreased sensaion Neoplasms

Best tx for acute hematoma? (1) vs Late treatment (2)

Acute: Strethcing. Late: Gentle heat and Phyiscal therapy

Deep br of lateral plantar n innervates

AdH DI: 1,2,3 PI: 1,2 Lum: 2,3,4

-Ilfeld's Disease:

Agenesis of the fibular sesamoid

Which graft type doesnt have osteoinduction?

Allogenic graft: own species, non-living cell, has no osteoinduction, not for nonunion!!

which type of graft can be used for a non-union

Allogneic graft

Onychogryposis

Also known as ram's horn or claw nails; an enlargement of the fingernails or toenails accompanied by increased thickening and curvature. "billy goats GRYPh"

why would an amide have higher *risk of toxcity* than an Ester

Am"i"de is broken down in l"i"ver so it is in the body longer with a greater chance of toxcity. Amides are longer lasting than esters, (esters are metabolized by pseuochlinesterase in blood)

SE of thiamine

Anaphylaxis, cyanosis, daiphoresis, restlessness Angioneurotic edema Urticaria Pulmonary edema Weakness, tightness of throat and nausea

Anatomical neck vs surgical neck of metatarsal

Anatomical neck (thinnest, proximal to surgial neck)

Nonhemolytic normocytic anemia

Anemia of Chronic Disease (ACD) Aplastic anemia (pancytopenia)

Fowler & Philip angle

Angle formed from the intersection of a line along the anterior tubercle and the plantar tuberosity and another line along the posterosuperior prominence at the Achilles tendon insertion Normal <70 Haglunds deformity >75°

ABI normal range abnormal ranges. give 3 examples of <0.55?

Ankle brachial index normal 0.9-1.4 >1.4=calcification 0.8-0.9= mild vascular disease 0.5-0.8=moderate vascular disease <0.55=severe vascular disease (gangrene, non healing ulcers, ishcemic rest pain

what is the clubfoot deformity? least and most common race

Ankle equinus hindfoot varus forefoot adduction asian least common polyneasain most common

-site of xray production -site of target -site of focusing cup -site of filament -% of energy is xrrays? Oil for? direction that e- travel?

Anode Anode Cathode Cathode only 1% of energy is conveted to xrays, 99% is heat. the *oil* is for heat exchanger E- travel from - cathode to + anode

plate: used for oblique fractures of the fibula. Its designed to prevent fragments of an oblique fracture from gliding upon eachother during axial pressure. The plate is fixed such that the tip of the distal fracture fragment is wedgned between the plate and the proximal fragment. ie buttress weber B fx with posterior spike. Prevent dorsal-superior displacement

Antiglide plate

Magic Angle Effect

Any MRI signal shot at *55 degrees* to the course of the tendon will show a false positive damage signal, Peroneals are common

murmur that is asymptomatic with elevated BP

Aortic regurg

Rheumatic fever, Marfans, syphilis, endocarditis, congenital. L. heart CHF from overloading. *High pitch diastolic murmur, low pitch rumble mid-diastolic/systolic murmur.* description of heart murmer, earlier diastolic murmer, weird pulses in feet

Aortic regurg "RA get high and rumble"

APGAR is a system to evaluate what categories? what is perfect score?

Appearance (color)-pink Pulse >100 Grimace active motion Appearance-completely pink Respiration-vigorous cry

what does the AO of the prinicples of internal fixation stand for? founder/ year of AO prinples

Arbeitsgemeinscaft Osteosynthesfragen "ow-bites-gimine-shaft" (switzerland) maurice muller 1958

ALARA radiology principle

As Low As Reasonably Achievable

what makes up the Trochanteric anastamosis

Ascending br of MFC Ascending br of LFC

EKG Dx: chaotic and erratic baseline (irregulary irregular) with *no discrete P* waves in between irregulary spaced QRS complexes

Atrial Fibrillation " AFi" A fib Irregulary irregular

EKG Dx: A rapid succession of identical, back to back atrial depolarization waves creating "Sawtooth" appearance

Atrial Flutter "Aflutter sawtooth"

Cardioversion is typically used with which rhythms (2) vs Defibrillation is typically used with which rhythms (2)

Atrial fibrillation or Atrial flutter (AF) vs Ventricular Fibrillation or Ventricular Tachycardia (VF,VT)

The bodys own phagocytic debridement, which is encouraged by a moist occlusive dressing such as hydrogel is what kind of debridement

Autolytic debridement

What function is lost first with spinal anesthesia?

Autonomic activity

Lack of Intrisic factor (IF) causes what type of anemia

B12 def (macrocytic anemia)

Lymphedema Pump Contraindications (11)

BIG DEC P Blood: PVD, Arterisclerosis, Ischemic vascular dz Infection Gangrene DVT Dermatitis Displaced fractures Edema 2ary to CHF Compartment Syndrome Pulmonary edema

large static magnetic field aka

BO: The B0 in MRI refers to the main static magnetic field and is measured in teslas. The majority of MRI systems in clinical use are 1.5 T, with increasing numbers of 3 T systems being installed. Altering the field strength will affect the Larmor frequency at which the protons precess.

Difference between bacteremia and septicemia

Bacteremia: Bacteria presence in blood, does not equal to infection. Septicemia: Actual colonization, localized infection 10^6

epidermal inclusion cyst

Benign cyst usually found on the skin developing from ectodermal tissue; Histologically, it is composed of a thin layer of squamous epithelium

inflammatory changes in small-medium arteries and viens caused by hypersensitivitey to tobacco. what is most important for healing?

Beurger Disease (Thromboangiits Obliterans). smoking cessation

Foster's fx:

Bil talar tubercle fx

Bimalleolar fx aka Trimalleolar fx aka

Bimalleolar: Pott's, M/L malleoli Trimalleolar: Cotton's, M/L and posterior malleoli (pic)

Cauda Equina Syndrome

Bladder/bowel dysfunction, sexual dysfunction saddle anesthesia, back pain with radiation to leg, absent Achilles reflex,

Which has highest intensity on ultrasound?

Bone (highest) (high impedance) Muscle Blood Water Fat Air

Cancer staging system (2)

Breslow: depth in mm and % 10 year survival rate. "hold your breath before diving deep" Clark: layers of skin. clark explores layers"

plate: modified neutrilizaton plates used to maintain lenght during healing without disrupting the damaged portion of bone. they act to bridge the bypass area of comminution. Screw are placed only in the major proximal and distal segments to avoid the fracture site

Bridge plate

what are the primary lesions (12)

Bulla, burrow, cyst, macule, nodule, papule, patch, plaque, pustle, tumor vesicle, wheal

Butress vs V shape thread has a geather resistnace to bending forces

Butress

types of periosteal response (5)

Buttressing (thick periostitis) Codman triangle Sunburst Onion Skin Hair on End

origin and insertion of poplieteus m

CKC O/I: tibial shaft above soleal line---popliteal groove on lateral epiconyle of femur

CMT I vs CMT II

CMT I: hypertrophic demilination CMT:II no hypertrophic demilination

clubbing nail systemic pathology (3)

COPD, cirrosis, congenital heart defects

Diminished bone density disease (5)

CRPS Rickets/Osteomalacia Scruvy Hyperparathyroidism Hyper/hypo thyroidsim "CRuSHH the bone"

Which imaging is the mainstay of diagnostic accuracy in regards to Lisfranc injury?

CT

gold standard to dx PE

CT pulmonary angiography

Gold standard to evaluate a calc fracture

CT scan

Jhamaria

Calcaneal index

CREST syndrome

Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia

pt with CHF, what medication shouldnt ve used

Calcium channel blocker

antibioic beads are commly mixed with what as its transport mech

Calcium sulfate

bloody stool micro (6)

Campylobacter E. coli E. Histoylytica Salmonella Shigella Yersinia enterocolitica

which type of scew has a larger pitch?

Cancellus scews (providing a larger surface area for scew to grab on to cancellous bone) (cancellus screws also have a lager thread to core ratio

Post MI markers: Cardiac tropoin 1 time frame -besides the heart what other organ is it found in? vs CK-MB time fame -what part of the heart is it found in?

Cardiac troponin 1: most specific protein marker "Im #1" (also seen in renal failure but studies have found that the increase resulted from the MI first.) increased 4 hr post MI for 2 weeks CK-MB: found in myocardium rises 6-12 hr post MI and returns to normal 2 days

normal anion gap? causes?

Caused be Metabolic Acidosis normal 8-12 Hyperventilation Addison disease Rrenal tubular disease Diarrhea Acetazolamide Spironolactone Saline infusion

what type of foot deformity is described bewlow: Increase cal inclination, decrease talar declination, decrease lateral/DP talocalcaneal angle, accentuation of sinus tarsi, increase MAA. claw toe, NV disorder(SMT), FF ADD, RF varus.

Cavus foot "CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.

why would a Cyclooxygenase 2 inhibitors be preffered in perioperative setting

Celecoxib (Celebrex) becuase is maintains platelet function w/o the GI side effects CI in sulfur allergy

Causes of nystagmus 3/12

Cerebellar nystagmus Congenital Spasmus nutans Acquired Pendular nystagmus: Jerk nystagmus: Other causes Lack of development of normal eye movement Albinism, nearsightedness(myopia) or astigmatism Congenital cataracts Inflammation of the inner ear Anti-epileptic medications or CNS disease

Ataxic gait is from which part of brain?

Cerebellum

Bridle Procedure treats what condition? what tendons are transfered (3)

Cerebral Palsy transferes TibP, TibA, PerL 443

Speech defects -retardation -ankle equinus -seizures -visual defects -upper motor neuron disease "scissors gait"; hyperreflexia, hypertonicity and spastic paralysis; presents with adducted knees and walking on toes Disease. most common tx for pes valgus deformity

Cerebral palsy. Evans lateral column lenghening

Sanders and Frykberg classification

Charco classification location: I. digits II. Lis Franc III. MTJ IV: ankle/STJ V: Calc

Classification based on the apex of the cavus deformity: Choparts joint? lesser tarsus bones? lisfranc joint?

Choparts joint= forefoot cavus lesser tarsus bones= lesser tarsal cavus lisfranc joint= metatarsal cavus

incision classicaly used for ST release in clubfoot

Cincinnati incision

A patient with a history of true penicillin allergy is scheduled for a total joint implant. Antibiotic prophylaxics would be (2)

Clindamycin Vancomycin

Dorsiflexory wedge osteotomy through naviculocuneiform joint and cuboid bone

Cole

schedule III drugs (5)

Combination products with less than 15 milligrams of hydrocodone per dosage unit *(Vicodin)* Products containing less than 90 milligrams of codeine per dosage unit *(Tylenol with codeine)* *Ketamine* *Anabolic steroids* *Testosterone*

myelomeningocele

Common and serious type of spinal bifida, spinal cord protrude out of defect. Lower motor lesion, flaccid paralysis,

2 locations for general bone stimulator uses:

Compression side: electro (-) current, osteoblast Tension side: electro (+) current, osteoclast (T,+, adding blood ca(osteoclast))

Pediatric deformity: Persion Slipper, reverse clubfoot, congential pes planovalgus aka Treatment:

Congenital Vertical talus Tx: closed reduction with casting rarley works. Open reduction is most succesful. goal is to do a posterior release and reduce the TN joint. If kid is >6 old, wait unilt osseus maturity and then do a triple arthrodesis

Apert's syn

Congenital massive multi-coalitions

Jurisprudence

Constitutional Law

most common in podiatry for OM of the Waldvogel classification

Contiguous

I dentify MRI muscle belly: Coronal T2 of abductor hallucis, abductor hallucis, quadratus plantae, abductor digit minimi

Coronal reformatted T2-WI showing clearly the hyperintense medial plantar veins (arrow) in normal conditions. The veins are surrounded by the m. abductor hallucis (1) medially; the m. quadratus plantae (2) deeply from the veins; and the m. flexor digitorum brevis (3) laterally. The muscle belly of the m. abductor digiti minimi (4) is located at the lateral plantar aspect of the foot.

40 YO M cough and fever: HIV + and is getting headaches - Disease? Tx

Crypto Meningitis - he has HIV Fluconazole: 400mg IV first day then 200-400mg qd

Cushing Dz vs Cushing syndrom how to diagnose cushing syndrome

Cushing dz: increased ACTH (tumors) Cushing syndrome: decreased ACTH (buffalo) Dx: Dexamethasone supression test will result in high dose=decreased ACTH, low dose =decreased ACTH

CAGE questionare

Cut down. Annoyed. Guilty. Eye-Opener. Each yes = 1 point. 1 point = ETOH abuse suspicion. >1 point = Strong Indication.

gold standard to diagnose osteoporosis

DEXA scan

Dorsiflexory wedge osteotomy of the 1st me or all mets

DFWO

disseminated intravascular coagulopathy. (DIC) def? "STOP Making New Thrombi"? PT, PTT, BT, PC?

DIC: widespread clotting--> deficiency in clotting factors--> bleeding state"STOP Making New Thrombi" Sepsis Gram-negative sepsis provokes DIC Obstetric complications actute Pancreatitis Malignancy Nephrotic syndome Transfusion -Increased PT, PTT, BT -decreased PC

where are of ivory phalanx, pencil in cup located?

DIPJ

DKA treatment order vs Hyperkalemia treatment order

DKA: INK I vs Hyperkalemia: C BIG K

Indications for wound vac, (7)

DM wounds Venous leg wounds Traumatic wounds Skin grafts pressure ulcer partial thickness burns flaps

Projection angle: DP projection of foot? DP projection of foot with marked lesion? Lateral foot? Lateral Raised digit/Hallux? Lateral oblique? Axial Sesamoid?

DP projection of foot? 15 DP projection of foot with marked lesion? 0 Lateral foot? 90 Lateral Raised digit/hallux? 90 Lateral oblique? 40 Axial Sesamoid? 90

Danis Weber fib fx Mech of injury location in lauge hansen Type A Type B Type C

Danis Weber fib fx Mech of injury location: Type A SAD 1 Transverse avulsion fx of lateral malleolus at or below ankle. Type B SER2, PAB3 Spiral fx of lateral malleolus at the level of tibial plafond (most common) Type C PER3 High fib fx, tibio-fibular syndesmosis rupture. (maisonneuve fracture)

RX treatment for Malignant Hyperthermia

Dantrolene 1. IV 2.5mg/kg rapidly 2. Oral 1-3 days after episode W502

What is the dose and drug you use in treatment for Malignant hyperthermia and how do you treat the arrhythmia caused by this pathology? moa for this drug

Dantrolene 2.5mg/kg IV; use Procanimide for the Arrythmia decreasing free intracellular calcium concentration

location for Incision DeVries vs Olliers vs Cincinnati

DeVries: medial vs Olliers: lateral vs Cincinnati: posterior

surgical dos/donts for OM in the OR (5 Ds)

Decompress: no tourniquet Drainage: lavage with plain NaCl Debridement: Excise necrotic, 2cm clear margin Dressing: Pack, open, place drain 2-3 days, daily dressing change Drug x 6 week PICC line IV, delay closure until culture

biguanides moa? DOC?

Decrease production of glucose in liver -Metformin (glucophage) SP72

Wellen's sign

Deep inverted T waves

anterior tarsal tunnel, anterior muscle compartment involves what nerve

Deep peroneal

Is Thrombotic thrombocytopenic purpura (TTP) a bleeding disorder or a hypercoagulable disorder Where does it affect? BT, PC

Deficiency in ADAM 13 -increase Bleeding time -decrease PC "FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities.

stock and glove style weakness, loss DTR, min muscle atrophy, sensory loss, ataxia, short stature, and scoliosis.Demyelination, nerve hypertrophy, slow nerve conduction.

Dejerene-Sottas (CMTIII)

-Delayed union def, time frame, tx vs -Non union: time frame (2), tx vs -Pseudoarthrosis: def, tx vs -Malunion

Delayed union: *beyond* average heal time. 3-6 month. strict immobilization vs non union: *>9 month old fx OR no change in 3 mo*. Bone stim, Revision, Bone graft vs Pseudoarthrosis: *fibrocartiaginous* develops at End stage non-union. Rrevision vs malunion: fx heals *anatomically incorrect* position

Most of blood supply to talus

Deltoid artery branch from Posterior tibial artery

Gottron sign

Dermatomyositis antinuclear antibodies in 80% pts

symptoms of hypoglyceia (6)

Diaphoresis(sweating)/syncope Tachycardia/palpatations Hunger Anxiety/irritability Tremors/seizures/mental confusion weakness

Defuse enthesophyte formation (ligmentous calcification).

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

rosenthal

Digital fracture classification/ tx: zone 1: completely distal aspect of phalanx: secondary healing zone 2: completly distal to lunula: flaps zone 3: distal to IPJ in hallux or DIPJ in lesser: distal symes amputation

Draw the nemonic for tetnus booster

Dirty >3 Td shots===none >5yr since last shot ===give Td Dirty <3 Td shots==Give BOTH Clean <3 Td shots ====give Td Clean >3 Td shots===none > 10yrs since last shot===Give Td

Structure for spinal block injection vs epidural block location

Dissection through the *dura matter* and the arachnoid matter and place it in the *subarachnoid space*. vs epideral space

why choose Distal over proximal akin

Distal akin: corrects IPJ Proximal akin corrects DASA

how to produce shortening and Plantarflexion with an Austins bunionectomy

Distal medial dorsal Proximal lateral plantar

most important of the cardinal principles of radiation protection is

Distance (inverse sqare law)

Parallel Pitch lines? If ______tubercle extends above superior parallel line=????

Draw a ling along plantar surface of calc, then draw a perpendicular that passes through the posterior aspect of the posterior facet At the point where the 2nd line passes through the posterior facet, draw another perpendicular line, parallel to the CIA If *posterior tubercle* extends above 2nd parallel line= *Hagland's deformity*

Dorsiflexory fusion through the MTJ

DuVries

disease: -progressive neuromuscular weakness -atrophy and muslce wasting affecting hips, pelvic area, thighs, shoulders, calves -loss of DTR -waddeling gait -secondary contactures -Proximal muslce weakness including neck m -Pseudohypertrophy of calves (fat depositis)

Duchenne's muscular dystrophy

lateral closing wedge or an opening medial wedge

Dwyer

surgical correction for a coleman block test with results in the hindfoot remaining in varus? how does the surgical correction correct the varus?

Dwyer: Lateral closing wedge (or an open medial wedge)

base of proximal phalanx is landmark for? 2

EDB inserts onto EDL. FDB splits so that FDL can pass through.

Hibbs Tenosuspension uses what muscels indication

EDL (cavus), hammertoes

Lateral terminal branch of deep peroneal nerve innervates (2)

EHB EDB

Medial oblique projection ankle xray: angle and beam focus

ER 45, beam on the vertical between the medial mall

3 lab markers for infection

ESR (0-30) >60 OM CRP (0-10) >3.2 infection procalcitonin(<2) >2-10

normal ranges ESR: CRP: Albumin: Pre-Albumin: ALT: AST:

ESR: 0-30 >infection CRP: 0-10 (0-0.1) <infection Albumin: 3.5-5 <malnutrion Pre-Albumin: 15-30 <malnutrition ALT: 0-30 >liver AST: 8-20 >(liver and MI)

difference between Eccine sweat gland and Apocrine sweat gland

Eccrine sweat glands open onto skin and are found all over body Apocrine sweat glands: open into hair follicules, found in armpit and crotch

Dermal infection, deeper more serious form erythromycin.of impetigo. May ulcerate.

Ecthyma

Diabetic abcess characterisitics (5)

Edematous Febrile Malodorous Purulent drainage cellulitis (clinical signs of)

Charco classifications (4)

Eichenholtz Brodsky Schon Sanders and Frykberg

null hypothesis

Either reject or fail to reject. Cannot prove null hypothesis, just means thereis or is not enough evidence to prove significance of the tested hypothesis.

common CI for joint implants (4)

Elderly non-ambulatory, young athlete (quicker failure), osteopenia, active infection

disease constantly present in a speficicaly smaller grouped population -common cold -chicken pox -malaria vs is a global or multiple county outbreak. -HIV/AIDS, -spanish flu, aisian flu ect , -SARS, vs rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. -meningococcal infections -black plague -yellow fever -polio

Endemic, Pandemic, Epidemic

Rule of 9's adult Entire Head = Chest (front) = Abdomen (front) = Upper back= Low back and buttocks = Each Entire arm = Groin = Each entire leg = hand vs foot=

Entire Head = 9% Chest (front) = 9% Abdomen (front) = 9% Upper back= 9% Low back and buttocks = 9% Each Entire arm = 9% (front = 4.5%, back = 4.5%) Groin = 1% Each entire leg = 18% total (front = 9%, back = 9%) hand=1.25% foot=3.5%

bone tumor locations acronym- Epiphysis (4) Metaphysis (8) Diaphysis (4)

Epiphysis: GCT, CB, CCC, IG "Interesting, Giant, is Clearly Blast" Met: O,O,O, CMF, NOF, CS, F, E "NO EFCS" Dia: ES, M, M, CS, "EF=M^2Cs"

Hibbs Tenosuspension Indication

Equinus without or without claw toesx`

infection of the skin, well demarcated that are swollen and indurated. caused by actute SUPERFICIAL form of celluitis involving the lymphatics. Its acute and symtoms consist of fever chills

Erysipelas vs Cellulitis deeper penetration into dermis and subq

Basal Cell carcinoma: cause/location? aka? vs Squamous cell carcinoma: cause/location?

Excessive sunlight or radiation "Beating sun/radiation" (upper face, sun exposed areas) aka rodent ulcer vs carcinogens (smoking, sunlight, ingestion of arsinic, radiation) "Squashed by carcionogens" (lower face, sun exposed areas)

Advantages of meshing in graft application (4)

Expands tissue size Allows drainage of hematoma/seroma Allows for irregular surfaces Increase SA for re-epitheliazation

what is the term that describes the *amount of ionization* that is produced when radiation passes through it?

Exposure

Hammertoe etiology:

Extensor Substitution

insertion for lumbricals

Extensor wing of respective digit

Ankle joint axis #s? axis direction?

F: 20-30 T: 8 S: 82 axis: Lateral plantar posterior to medial anterial dorsal

STJ axis

F: 48 T: 42 S: 16

Midtarsal joint longitudinal axis vs Oblique axis

F: 75 T: 15 S: 9 vs F: 38 T: 52 S: 57

Infracalcaneal spuring is caused by

FDB (not plantar fascia)

Vertice ridge of tibia seperates what 2 muscles

FDL (medial) (dick) TP (lateral) (tom)

Plantar proper digial br of the superficial division of the lateral plantar n innervates

FDMb DI: 4 PI: 3

Intrinsic posting does what to FF

FF balanced on RF vs extrinisch posting: FF non balaned on RF

Emergent reversal of Warfarin vs non-emergent but quick reversal of warfarin? vs non-emergent, slowest reversal of warfarin?

FFP vs IV vit K vs oral vit K (most common form of vitamin K) it also doenst have the SE that IV vit K has

Plantar proper digial br of medial plantar n innervates

FHB

sesamoids act as apulley for what m

FHB

FDL vs FHL which is stronger when compared for a tendon transfer for posterior tibial tendon

FHL

T:F OSHA requires medical and dental offices to maintain an official log of reportable injuries and illnesses

False

how to Dx DM: fasting blood sugar? oral glucose toloerance test? A1c?

Fasting plasma glucose >126 Oral glucose tolerance test >200 A1c >6.5

secondary centers of ossificatin from Femur (4), patella, tibia (2)

Femoral head: 1 year age Greater trochater: 4 yr age Less trocanter: 13 yr age Distal femur: 9 mo FD Patella: 4 yr age Proximal tibia: 9m Distal tibia: 1-1.5 yr age

most common ST sarcoma of adult

Fibrous histiocytoma

Indication for arthroereisis (2)

Flexible pes planus PTTD

tarsal tunnel borders

Flexor retinaculum Calcaneus and posterior talus distal tibia and medial mal

Reye Syndrome (RS)

Flu complication, when children are given Asprin: a disorder defined as a metabolic encephalopathy associated with other characteristic organ involvement. It is characterized by fever, profoundly impaired consciousness, and disordered hepatic function

Reversal agent for benzos for benzo overdose anything ending in "-am", others include Chlordiazepoxide or Clorazepate

Flumazenil

what is the xrya machine that aloows real time moving images

Fluroscopy

what are the macrocytic anemias

Folate acid def Vitamin B12 def (neuro symtoms) megalblastic anemia Orotic aciduria phenytoin, cytotoxic meds W322

total angle of ruch

Fowler & Philip angle + calcaneal inclination angle Normal 90° Haglunds deformity >90°

3 angles to assess hanglunds deformity? radiographic pathology angle for each?

Fowler-Philip angle? >75 Total angle of ruch: >90 Parallel pitch lines: post tubercle popping up

Partial matrixectmy options? (4)

Frost modified frost plastic lip Winogad

types of frostbite (5)

Frostnip (mildest): short exposure Chillblains (pernio): repeat exposure with humidity Trench foot: prolong exposure high altitude mechanism

which bone scan is CI in kids

Gallium 67

posterior leg muscles from superficial to deep

Gastroc Plantaris Soleus

Best treatment to lengthen heel cord with a positive silverskoid test

Gastroc recession because weve isolated that the equinus is due to the gastroc. After gastroc recssion is performed the equinus is fixed positive test= can AJ 0 degree with knee straight AJ 10 degrees with knee flexed)

most common lysosomal storage disease

Gaucher dz (hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises, gaucher cells)

Recently went hiking and now has GI disturbance - most likely cause? Tx

Giardia - drank river water treat with Metronidazole

most common primary intracranial tumor

Glioblastoma "GLI im #1"

"MARTEL the RAT is SWELLING from EROSIONS and PUNCHED out the wall but SPARED the JOINT SPACE

Gout: Martels sign rat bite increased swelling erosions, punched out lesions Joint sparing

pretibial myxema is associated with

Graves (hyperthroidism)

Both pretibial myexedam and Exopthalmus are found only in

Graves disease

Ecthyma (Dermal infection, deeper more serious form erythromycin. of impetigo. May ulcerate.)micro

Group A strep

two micro bugs that can cause fever within a few hours of surgery

Group A strep (GAS) Clostridium perfringens

hexacarbon abuse can mimic what micro bug

Guillian barre (casues ascending paralysis)

diagnose: -long 2nd metatarsal -oval or rounded first met head -women -hypermobility

HAV

Roots classification (4 stages)

HAV: 1. sagittal groove formation 2. HAA and PASA inreased, ADL bowstring 3. IM increase 4. End stage, subluxed hallux

Hepatitis B, needle stick, what to look for in serum

HBsAg

*Proximal white onychomycosis* with rapid extension from the proximal to the distal nail is unusual but can be suggestive of?

HIV or other conditions of immunocompromise

which health care has a "gatekeeper"

HMO An HMO is a closed health care system where all access to care is controlled by the primary care provider (gatekeeper).

difference between HMO and PPO

HMO: -may require you to select a (PCP), who will determine what treatment you need. -may need a PCP referral (a gatekeeper) to be covered when you see a specialist or have a special test done. -If you opt to see a doctor outside of an HMO network, there is no coverage (out of pocket), -*Premiums are generally lower* for HMO plans, and there is *usually no deductible or a low one.* PPO: -You can see the doctor or specialist you'd like without having to see a PCP first. -You can see a doctor or go to a hospital outside the network and you may be covered. However, your benefits will be better if you stay in the PPO network. -*Premiums tend to be higher*, and it's common for there to be a *deductible.*

HMO cost, coverage and restrictions

HMOs tend to be: -more affordable -less coverage -more restrictions.

when should a chemistry profile be ordered preop (7)

HO hypertension, diuretic use COPD obstructive slee apnea DM renal disease chemotherapy

Removal of both sesamoids what can occur

Hallux Malleus can form

What are standard precautions?

Hand washing and PPE(personal protective equipment)

Hapalonychia: Herpetic whitlow: Hippocratic nails: Intraungal hematoma:

Hapalonychia: hyperhidrosis causes rubbery nails Herpetic whitlow: herpetic infection at distal phananx Hippocratic nails: clubbing nails Intraungal hematoma: hematom within body of nail

Hard vs Soft xrays: -kVp -wavelenght -frequency -penetration -energy

Hard: -produced by increased kVp, -short wavelenght, -high frequency, -increased penetration, -less dangerous to pt, -higher energy above 5-10kVp vs soft: produced by decreased kVp, long wavelenght, low frequency, low penetration, lower energy, more dangerous to pt

best xray to view STJ coalitions most common cause of tarsal coalition

Harris-Beath failure of segmentation of primitive mesenchym.

-Talar neck fracture classification name: -% AVN for each type? -Hawkins sign

Hawkins: Type I: *talar neck* without displacement (AVN risk 10%) Type II: add *STJ* (AVN risk 42%) Type III: add *ankle*, (AVN risk 91%) Type IV: add *TNJ* (AVN risk 100%) Hawkins sign: Represents sign of viability. Its subchondral atrophy due to hyperemia, usually seen 6-8 weeks after injury

Heat stroke vs. Heat exhaustion

Heat stroke Fever above 104F, irrational behavior, extreme confusion, dry, hot and red skin, rapid and shallow breathing, rapid and weak pulse, seizures and unconsciousness. can progress to damage to organs and brain, extreme cases can cause death Heat exhaustion Headache, dizziness and light-headedness, weakness, vomiting and nausea, cool and moist skin, dark urine. If do not feel better within 30 minutes, can progress to heat stroke. Kim had this in moab. she was exhausted.

Wells score

Helps estimate the risk of a patient having a deep vein thrombosis

stages of healing/ time frame (4). which stage does contracture occur (healing occuring as wound gets smaller towards the center)

Hemostatis: 2min- 2hours Inflammatory (substrate): 2 days *Proliferaative.* (fibroblastic): 2-3 weeks Remodeling (maturation): >>2-3 weeks

fibula bone autograft is harvested via which tecnique

Henry approach

DNA virus associated with Membranous and membranoproliferative glomerulonephritis, arthralgia, poly arteritis nodosa

Hepatitis B

What is Ramsay Hunt syndrome?

Herpes infection in ear and facial paralysis

pes cavus tendon transfers (4)

Hibbs Jones STATT PT transfer "CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.

Highs TENS vs Low TENS

High 100-500 Hz blocks pain receptors, can use up to 24 hours per day, cause when off the pain comes back Low 1-50 Hz produces endorphins 15-30min

how to calculate ABI? left PT: 110 left DP:100 left arm: 130

Highest DP or PT Systolic /Highest RUE Systolic 110/130= 0.84 (L ABI)

Reed-Sternberg cells

Hodgkin's lymphoma

what is the procedure to treat RA, HT by resection of the 1st MTPJ and excision of the lesser MT heads

Hoffman-Clayton

what law describes strain (deformity) of material is proportional to stress applied

Hooke's law: strain (deformity) of material is proportional to stress applied

Hyper vs hypoglycemia: onset? neuron damage?

Hyper- slow onset Hypo- rapid onset Hypo-neuron damage

Loop Diuretic SE (5)

Hypokalemia, hyperuricemia, glucose intolerance, hypercholesterolemia, sexual dysfunction.

De Quervain: general

Hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens

Mallampati Score

I - soft palate, fauces, uvula, tonsillar pillars II - soft palate, fauces and uvula III - soft palate and base of uvula IV - soft palate not visible

Rowe classification. I A-C (which would be confused with a calcaneal secondarius) II A-B III A-B IV V

IA: medial calc tuber, IB: sustentac IC: Ant proc (confused with calc secondarius) IIA: "Beak fx", no achilles, IIB: "tongue fx" avulsion of achilles IIIA: Simple ext-artic, IIIB: Comm ext-artic IV: Comm intr-artic body fx with/o depression V: Comm intr-artic body fx with depression W476

what schedule durg is Percocet

II (high abuse potential, Rx required)

calculate True IM angle

IM + (MA-15)

splay foot

IM angle >12 with 4th and 5th met ankle >8

Lateral oblique ankle xray: angle and beam focus

IR 45, lateral mall.

heloma molle location 3rd interspace (2)

IS3: head of 3rd proximal base of 4th middle (or head of 4th prox and base of 3rd middle)

Ober test

IT band tightness

ASA class? Cardiovascular disease Renal disease with renal impairment unstable angina symptomatic COPD

IV Mcglamery 56

Protected health information definition

Identifiable, demographics medical history, mental health, diagnostic, lab test, blood work treatment info Payment info

Harvesting sites for bone autograft (7)

Iliac crest Rib Greater trochanter Fibula Proximal tibia Distal tiba Calc

where is physis on bone located

Inbetween epiphysis and metaphysis

How do you prevent atelectasias in a pt with Pulmonary Disease? (3)

Incentive Spirometry CPAP Stop smoking

Limb lenght Discrepancy. what is seen on the short side (3) If its not listed in these 3, its safe to say the remainder of the compensations are on the long side.

Increased STJ supination Increase pelvis height Increased shoulder height

hyperparathyroidism: (4)

Increased osteoclast hypercalcemia bone resorption hypophosphatemia

thiazolidinediones moa? 2 drugs?

Incrrease peripheral cellular response to insulin -Rosiglitazone -Pioglitazone P72

DOC for acute gout /other options (2) DOC for chronic gout / other options (2)

Indomethacin (other options: cholchicine, predisone) Allopurinol (other options: Febuxostat, Pegloticase)

most common causes of immediate post op pain when narcotics dont releive pain? (3) post op pain after 48 hours is due to (6)

Infection, Hematoma, Dressing pressure >48 hours -sutures too tight -dressing too tight -hematoma -edema (foot in dependant position) -Vasospasm from K wire -Compartment syndrome

PEDIS system

Infectious disease socicity of america to evaluated serousness of an ulcer. each topic gets scored 0-2, Perfusion Extent Depth Infection Sensation

cortical bone infection only

Infectious osteitis

Inflammation at or near the insertion site with swollen, taut skin with pain. Blanching and coolness of skin around IV site. No backflow of blood into IV tubing on lowering the solution container

Infiltration (needle goes right through the vien)

Thromboangiitis obliterans (Buerger disease)

Inflammation of the medium-sized arteries and veins because of thrombotic occlusion, resulting in ischemia and gangrene.

First branch of saphenous nerve

Infraptellar branch

Anodyn therapy use

Infrared to increase circulation, reduce pain, stiffness, muscle spasms

Anodyn therapy moa

Infrared to increase circulation, reduce pain, stiffness, muscle spasms causes local release of nitric oxide which stimulates vasodilation to increase circulation

by day 3 of graft healing what is happening

Inosculation phase: capillary buds make contact with graft

Inspiration vs expiration chest movment/diaphragm?

Inspiration: diaphragm contracts, chest expands Expiration: diaphragm relaxes, chest contracts

CMT affects muscels in what order?

Instiniscs (smallest muscles), PB, PL, TP, Surae (largest)

lemont's nerve

Intermediate dorsal cutaneous

what are the stages of PVD

Intermittant claudication Rest pain Gangrene

ABI intermittant claudication score vs rest pain

Intermittant claudication: 0.5-0.89 rest pain: 0.2-0.49

Interosseus lipoma on xray and MRI Xray: if in calc, its in anterior process. Osteolytic lesion with central calcified nidus. commonly within neutral triangle of calcaneous MRI: MRI also shows the signal intesnity of fat

Interosseus lipoma

lumbrical, interossi, neuroma in relation to DTML

Interosssi-dorsal *DTML* lumbrical, neuroma-plantar

what is Engles angle? normal? greater or lesser=metatarsus adductus.

Intersection between 2nd met with medial cun. normal is 18-24. increased is MA

stewart 2 fracture

Intra-articular base of 5th met base

difference between STJ arthroreisis implants Intraosseus vs Extraosseus ar

Intra=requuire bone resection (not used much anymore) extra: no bone resection, instead its simply screwed into place Type 1-sinus tarsi Type 2-narrower which allows them to penetrate sinus tarsi and deeper canalis portion of sinus tarsi

Osteolytic lesion surrounded by a thin, well defined sclerotic border. Internal osseous ridges are frequently present and bone expansion seen, in neutral triangle of calcaneous

Intraosseus lipoma

is Von Willebrand disease a bleeding disorder or a hypercoagulable disorder?

Intrinsic pathway coagulation defect -increase to normal PTT. Increased bleeding disorder

Inverted Blake posting

Intrinsic varus posting

6 month old, what is the most common cause of anemia?

Iron deficiency anemia due to GI absorption issues

what view is used to see the STJ factets on xray

Isherwood W202

Difference between Isherwood and Harris and beath

Isherwood: anterior facet of STJ Harris and Beath: Middle and Posterior colalition

what anesthetic agent has the lowest MAC? and a low MAC= how potent?

Isofurane "ISO potent" (making it the most potent): Inhalated anestheic that decreases BP by vasodilation only. No cardiodepressant actiity. (Isufurane, desflurane and succinylcholine are only 3 drugs that can cause malignant hyperthermia) W56

anesthetic with the lowest MAC

Isofurane (most potenent) and pungent

muscle contraction with associated joint motion and change in muscles lenght. Can be preformed in a cast (free weight exercise

Isotonic

Explain how the STJ is a torque converter

It converts transverse leg motion to triplanar motion of the foot. (tibia rotates on femur creating a shearing force, STJ translates this force to transverse plane motion of the foot)

Dorsiflexory wedge osteotomy across the tarsometatarsal joints

JAHSS procdure for cavus deformity

MRI classification for PTTD

Jahass or Janis classification

V-osteotomy of midfoot with the apex of the V most proximal located in navicular and the lateral distal cut extend to cuboid and medial limb

Japas

Junctional Nevi vs Dermal Nevi (Intradermal Nevi) vs compound Nevi

Junctional: flat and hyperpigmented Dermal: raised and flesh colored, sometimes pigmented, rarley malignant compound: raised and hyperpigmented combo between junctional and dermal type

voir dire

Jury selection process of questioning prospective jurors, to ascertain their qualifications and determine any basis for challenge.

arthritis association Iridocycolitis vs conjunctivitis

Juvenile rheumatoid arthritis vs Reiter syndrome

difference between K wire and Steinmann pin

K wire are smaller in diameter (inches) and Steinmann pins

total matrixectomy options (5)

Kaplin Suppan #2 Syme (lapidus) Whitney Zadik

Chilectomy with proximal hallux phalanx resected

Keller

Arthroplasti options for 1st ray surgery of hallux rigidus(4)

Keller Mayo-heuter Stone Valenti W399

tissues lease sensitive to radiation (3) vs tissue most sensitive to radiation (4)

Kidney, muscle, nerves vs bone marrow with lymphocytes, reproductive cells, GI

Pedal hyperhidrosis is generally found to be caused by

Kytococcus sedentarius.

most common sciatic disc location

L4-5

L4 vs L2 vs L1 radiculopathy symtoms

L4or L3: anterior thigh/leg L2: antero-medial in the thigh L1: groin

meromelia

Lack part of a limb

what more closely mimics human plasma with a pH of 6.5, more so than normal saline? contents:(5)

Lactated Ringers contents: Na,Cl,K, Ca, lactate

Guillan-Barre aka

Landry's Paralysis

what causes a faster, darker image film? (2)

Large size of the AgBr crystals thicker the emulsion layer

which Isherwood position is used to see the posterior facet of the STJ?

Lateral Oblique Axial Position W202

What view can you not see os peroneum

Lateral oblique will not see os peroneum

attachement for Posterior Talofibular ligament

Lateral tubercle---Lower portion of malleolar fossa

if someone had reaction to lidocaine what is it most likely it is? (2)

Latex, PABA,

Amputation: the calcaneus is sawed through horizontally instead of vertically so that the pt steps on the same pard of the heel as before

Lefort (boyd) amputation ( modification of pirigoff)

MRI T1 vs T2 hemangioma

Left: T1 Right T2

MRI T1 vs T2 fracture line

Left: T1 Right: T2

stare decisis

Let the decision stand (the rule that a court tends to follow its previous decision based on similar facts)

What are the amide local anesthetics?

Lidocaine, Mepivacaine, bupivacaine, Ropivacaine (less cardio toxicity than bupivacine, $$$) (amide's have 2 I's in them)

False Claims Act aka

Lincoln Law

Lindsay nail: describe and cause Mees lines: describe and cause Muehrcke nails: describea nd cause

Lindsay nail: distal half is pink, proximal is white (pic) due to liver disease and azotemia Mees lines: single traverse white band-arsenic Muehrcke nails: horizontal white band, hypoalbumemia

most common ST tumor of all ages

Lipoma

Chondomyxoid fibroma, giant cell tumor and ABC have what in common

Lobulated, Expansitile (pic is chondromyxoid fibroma. notice the scalloped borders

Initial treatment for acute DVT treatment

Lovenox =enoxaparin (1mg/kg SC q 12)

Highest CA mortality

Lung CA

Physcial therapy with manal lymphatic drainage, massage and exercise is first line tx for

Lymphadema

Brown tumor of hyperparathyroidism

Lytic bone lesion that develops with persistent hyperparathyroidism that gets its color from abundant hemorrhage and hemosiderin within the lesion

difference between MA, skew foot, Club foot

MA is metatarsals only skew foot involves rearfoot pronation clubfoot involves rearfoot supination

C-N coalition will see comma sign on what view?

MO view

Lachman's Test

MPJ ligament stability (>2mm displacement=(+) test)

what/why is the most specific and most sensitive imaging modality of diagnosing OM

MRI-can detect OM as early as 3-5 days pic is T2: bone marrow edema central high signal (fluid)

Disease: -any neurological symtom of weakness, -tingling, -numbness, -blurred vision -women 2:1 -upper motor neuron disease

MS

elftman theory? which Mid tarsal joint is the key to stability according to elftman?

MTJ locking and unlocking. CC is the key to stability

joint type in foot: Ellipsoid

MTPJ

soft palate, fauces and uvula

Mallampati score 2

soft palate and base of uvula

Mallampati score 3

soft palate not visible

Mallampati score 4

soft palate, fauces, uvula, tonsillar pillars

Mallampati score I

MESS score acronym

Mangled Extremity Severity Score

Ankylosing Spondylitis aka

Marie-Strumpell's disease

what is the carcinoma most frequently associated with chronic venous ulcers Marjolin's ulcer

Marjolin's ulcer (SCC)-Cloaca malignant degeneration

Dorsiflexory fusion of the 1st metatarsal-medial cuneiform joint

McEvenny-Caldwell

when is EKG recommened preop mcglamery? (3) other sources? "DICCCS"

Mcglamery 57: HO heart disease men >40 women >50 other sources: "DICCCS" DM, Ishcemic cardiac disease cerebrovascular dz, CHF, cr >2.0, smoking, lung disease

club foot on xray (3)

Mearys) > 15 (positive mearys seen in cavus foot types) Kites <15 Metatarsal stacking (indicates forefoot supination)

AFO height of the device

Measure from the plantar surface of the heel to the posterior apex of the patients calf Proximal edge of calf segment equals the measurement

which Isherwood position is used to see the middle facet of the STJ?

Medial Oblique Axial Position W202

which Isherwood position is used to see the anterior facet of the STJ?

Medial Oblique position W202

origin of quadratus plantae

Medial and inferior surface of calcaneus

DeVries Incision:

Medial longitudinal

which medicare coverage is supplemental

Medicare Part B, for which the policyholder pays a premium

6 months swelling distal toe, brown to black discolouration of the toe nail. Which type of cancer?

Melanonychia

how is the Bleck Classification drawn?

Met Adductus bisection of calc compared to 2nd digit

what angle is most important to evaluate Met adductus vs HAV? whatare the normal valuse for: -IM -hallux abductus -PASA-draw it -DASA- draw it -Hallux abductus -Interphaangeus -Met protrusion -Tibial sesmoid position

Met adductus angle for MA: normal 15 *IM 8-12 most important for bunionectomy eval* Hallux abductus 0-15 PASA 7.5-12 (left pic) DASA7.5 ( right pic) Hallux abductus Interphaangeus 10 Met protrusion 2mm Tbial sesmoid position 1-3

Statistic combination of data from several studies

Meta-analysis

Bebaxe shoe use (2) how is it adjusted (1)

Metatarsus adductus club foot (adjust using allen wrench) "BEBAX and rocksteady work with allen wrenches to fix club foot and MA"

flexor stabilization (pronated foot and aductovarus of 4th and 5th toes) occurs when during gait Flexor Substitusion occurs when during gait Extensor Substitution occurs when during gait

Midstance "midstance grips the floor with pronation and adductorarus 4th and 5th" Pre-swing Initial swing

Young women, can be asymptomatic. *Late systolic murmur with mid-systolic click.*

Mitral prolapse "PM click it or tickit"

Rheumatic fever, endocarditis, MI, prolapse. L. heart failure, then R. side failure. *Holosystolic, constant intensity, blowing murmur*

Mitral regurgitation "RM is holyo"

bacterial endocarditis what heart valve is most commohly affected? What other vinnet triggers are associated with bacteraial endocarditis

Mitral valve most common "Bacteria FROM JANE" Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail bed hemorrhage Emboli

EKG dx: Dropped beats that are not proceded by a change in lenght of the PR interval (as in type 1), treated with a pacemaker

Mobitz type II

Morphine half life Codeine has a half life of Tramadol has a half life of Hydrocodone has a half life of which one is shortest? which one is longest?

Morphine has a half life of approximately 1.5--2.5 hours. (peak is 30-60 min) Codeine, Tramadol, and Hydrocodone all have longer half-lives. Codeine has a half life of 3 hours. Tramadol has a half life of 6.3 hours Hydrocodone has a half life of 4 hours.

difference between AP and Ankle mortis view

Mortise: can see talar dome and medial and lateral gutter clearly AP: can see lateral talar gutter becuase there is overlap

is Factor V Leiden a bleeding disorder or hypercoagulation disorder? what does it affect.

Most common *hypercoagulable state*, mutated factor V that is resistant to , Protein C and Protein S cleavage. Increased risk of thrombosis

19YO F LE weakness and 10 minutes of blindness - cause?

Multiple Sclerosis

Scanning speech/nystagmus → seen in

Multiple sclerosis

spastic CP treatment of equinus

Murphys procdure

Most common PACU complication

N/V

-calculate normal calcaneal stance position -calculate TI

NCSP= STJNP + TI TI=Max pronation + Eversion

Treatment for Pseudogout

NSAIDS Imbolization analgesics

Treatment for Psoriatic Arthritis (3)

NSAIDS sulfasalazine steroids

Treatment for Reactive arthritis

NSAIDS tetracycline following chlamydial infection

anion gap equation

Na - (Cl +HCO)

Signs of salicylate toxicity (5)

Nausea, vomiting, diaphoresis (sweating) tinnitus, tachycardia

Watson jones stages for what tarsal bone? most common stage?

Navicular fractures 1: Tuberosity fx: PT tendon avulstion *2: Dorsal lip fx: most common* 3a: Nondisplaced body fx, 3b: Displaced body fx. 4: stress fx. intraarticular,

Scwannoma types

Neurofibroma: rubbery on palpatio Neurilemmoma: solitary, painless

picture of nodule and when you push on it it retracts into the skin, what is it?

Neurofibromatosis

plate: protectes interfrag compression screw at the fracture site from normal bending, and rotational axial loading forces

Neutrilization plate

A skin finding in which top layer of skin slips away from lower layer when slightly rubbed. Seen in Bullous Diabeticorum

Nikolsky sign

WEBER & CECH classification? which has the greatest chance for healingf

Non-union *Hypertrophic callus: * "Hyper animals" -elephants foot large callus (greatest chance for healing) -horse hoof (minor callus) -oligotrophic (absent callus) *Atrophic: No callus* -torsion wedge (one end healed, other end not) -comminuted (intermediate frag is necrotic) -atrophic (end result of non-union, both ends are osteoporotic) -Defect (loss of fragment between two ends M6

normal INR w and w/o warfarin

Normal INR without Warfarin: 1 INR on warfarin: 2-3

2 risk assessments scales for pressure ulcers

Norton Scale Braden Sclae

Synvisc, hyalgan and orencia are biopharmaceuticals used to treat

OA

causes for marrow edema on MRI (2)

OA fractures

apatite crystals

OA inflammatory arthritis calcific periarthritis

Aspercream is a topical used as relief for (4)

OA, tendonitis, ligament injury, any inflammation

"osteoPHYTE the EBURN from DJ MICE b/c he is ASyMMETRIC NARROW minded

OA: osteophytes eburnation DJD joint mice in articular space Asymmetrical joint space narrowing

bone marrow infection

OM

cierny mader classification

OM classiication that combines anatomical with phyisiological causes

Waldvogel classification? most common?

OM occurs in one of 3 ways: 1. hematogenous (via bloodstream) most common in general, but not in the foot. 2. contigous (adjacent ST) 3. direct inculation (trauma or surgical) W269

difference between obstructive and restrictive lung disease

Obstructive: obstruction of air flow resulting in air trapping in lungs Restrictive: restricted lung expansion causes decrease lung volumes

what does OSHA stand for

Occupational Safety and Health Administration

Amelonotic melanoma

Occurs when a melanoma arrises from a melanocye devoid of pigment, may occur from any of the 4 most fommon types of melanoma

Ogden VII: Ogden VIII: Ogden IX:

Ogden VII Epiphyseal Ogden VIII metaphyseal Ogden IX periosteum stripping

Oligodendrocytes vs Schwann cells

Oligo: CNS schwann: PNS

What 2 incisions are made for triple ollier incision use

Ollier: (pic) tip of lateral mall to base of 4th met to access STJ, CCJ Medial: medial gutter to 1st met base to access TNJ and TC fixation

Describe Laminated periosteal reaction? seen in what bone tumor?

Onion skin appearance - Ewings Sarcoma

Onychatropia: Onychauxic: Onychia: Onychoclasis: Onycocryptosis: Onychogenic: Onychoheteroptia: Onychomadesis Onycophosis: Onychopuntata: Onychorrhexis: Onychoschozia: Onychotillomania:

Onychatropia: atrophy (pic) Onychauxic: thickening "cake makes you thick" Onychia: inflammation of matix Onychoclasis: breaking "clashing nails breaks them" Onycocryptosis: Ingrown Onychogenic: producing nail substance Onychoheteroptia: nail in abnormal place Onychomadesis: seperation nail from bed "seperate from mother n law" Onycophosis: callus in nail groove Onychopuntata: Pitting Onychorrhexis: brittle "brittle nails are easily recked" Onychoschozia: splitting/flake in layers "schozia are flakes" Onychotillomania: picking at nail "manic picking nails"

cotton flatfoot correction

Open dorsal wedge of 1st Cuneifom

Bone tumor that resembles and was once considered a large osteoid osteoma?

Osteoblastoma

Voorhoeve's dx. Linear band of dense bone, hip, unknown etiology,metaphysis/diaphysis

Osteopathia Striata

spotty bone dx, multiple dense areas. epiphysis/metaphysis only.

Osteopoikilosis

Contraindications for US (7)

Over spinal cord, open epiphyseal growth plates, bony prominences, fractures and acute infections, menstruating uterus, laminectomy, vascular disease, insensate skin metal implants, pacemakers

Lag by design omits

Overdrill

depolalization of atria depolarization of ventrical repolarization of ventrical

P QRS T

Lauge hansen lateral spike fracture

PAB stage 3: transverse or comminuted fracture of fibula at the level of the syndesmosis (lateral spike)

dependant rubor vs rubor with elevation

PAD vs Infection

Reverdin bunionectoomy is primarily used for increased ______angle

PASA

antagonist of the TP

PB

which cancers are most likely to metastisize to the bone: (5)

PB KTL Prostate Breast Kidney Thyroid Lung

most common preventable hospital death

PE

Lauge hansen masioneuve

PER 3 "PER is worst kind just like Mason"

action of foot lumbricals (3)

PF proximal phalanx Extend middle and distal phalanges Contraction causes tightened WING and slacken SLING components of the extensor hood

which is faster absorbed: PGA vs PLA

PGA is faster, these are the 2 types: PGA: polyglycolic acid, PLGA: poly lactic-co-clycolic acid

what is peroneus longus tendon transfer? indication?

PL is released at cuboid and inseerted to the lesser tarsus or bast of 3rd met Indicated for drop foot or pes cavus

PPO cost, covergae and restrictions

PPO: -higher price tag and probably a deductible -greater coverage -more flexible and provide

INR is the standard value for? PT or PTT

PT

treatment for ankylosing spondylitis

PT NSAIDS

Weinraub and Heilala classification for what condition?

PTTD

most common reason to prescrive Richie or Arizona brace

PTTD

cobb procedure

PTTD: medial 1/2 of anterior tibial tendon is transferred thorugh a drilled hole in the medial cuneform or navicular. and reconstruction of PTT is preformed -best procudre for stage 2 PTTD

Johnson and strom classification which stages are flexible vs rigid? which stages involves What is helbings sign

PTTD: stage 1: flexible mild degeneration tx conseravative, tendon debridment stage 2: flexible tendon degereration tx tendon transfer, RF arthrodesis, A-<30% TN head uncovering, B- >30% TN head uncovering stage 3: rigid= ruptured tendon and elongated, weak heel rise tx triple arthrodesis, AFO bracing stage 4(myerson): rigid = same as 3, rigid ankle valgus tx TCC or pantalar, AFO bracing Helbings sign: Positive is when there is a lateral concavity of the achiles. (no pull of PT means foot has un-opposed eversion) (pic)

General term for a Patient with decreased pulses, pain after walking acertain distance, decreased hair growth

PVD

MRI contraindication (7) -is internal fixation CI with MRI?

Pacemaker, metal clips, metal valves, metal sints, silvers of metal embedded into eye, choclear implants, stents, internal fixation NOT CI with MRI, but recommended that hardward be in for at least 6 weeks

Allodynia vs hyperalgesia

Pain from a stimulus that doesn't normally cause pain an extreme, exaggerated reaction to a stimulus which is normally painful

pseudo-claudication

Pain when walking that mimics vascular claudication but is due spinal stenosis

Lister's Corn

Painful corn in lateral groove of the 5th toe from varus rotation of phalanx

Inflammation involving the folds of tissue around the nail

Paronychia W284

what are the medicare plans A-C?

Part A covers inpatient care, skilled nursing facility, and in limited circumstances, at home nursing . Part B covers lab tests, surgeries, and doctor visits including *podiatry*. Part C covers additional benefits, such as vision, dental, and hearing, and many include prescription drug coverage

SLE radiographic findings? *what would be found on peripheral blood smear*

Periarticular osteopenia and soft-tissue swelling without erosions. *hemotoxilin and eosin, rosetts*

65 degrees of dorsiflexion are required at the 1st MPJ for propulsion, however only 30-40 occur passively. The rest comes from what?

Peroneus longus.

calcaneus ABD and EV, talus PF. Flexible: tight achilles, reducible. Rigid: coalition, bone blocks, nonreducible. Increase talar declination, decrease calc inclination, increase lateral talocalcaneal angle, midfoot faults, anteriorly displace cyma line. Obliteration of sinus tarsi, decrease talar head coverage, decrease MAA.

Pes planovalgus

Epinephrine use is contraindicated in pts with

Pheochromocytoma

Photoelectric effect: vs comton effect

Photoelectric effect: this occurs at lower kVp when an x-ray photon colides with a lower shell elctron. and the elctron is ejected and another highter shell elctron fills its space, releasing enery. This is beneficial to the image, but results in greater absorption of radiation to the pt (pic) The compton effect occurs when an x-ray photon interacts with an outer shell electron. The compton effect occurs mostly above 80kVp. It cuases less radiation to the pt and is detrimental to the image

Inflammation and thickening of synovial lining. Hip or knee, increase synovial fluid production, joint edema, pressure erosion, pigment due to hemosiderin laden macrophage. MRI preferred diagnostic tool. Tx: synovectomy.

Pigmented Villonodular synovitis

make up of Zosyn

Pipercillin/Tazobactam

Amputation: Sectioning the talus and calcaneus in line with the anerior margin of the tibia therby preseving the posterior portion of the calcaneus, heel wiehgt bearing surface and insertion of the achilles tendon

Pirigoff amputation

what is the difference between cortical and cancellous cortical is _____x stiff than cancellous bone?

Pitch =distance between each thread. (cortical has smaller pitch so that it can engage more of the bone 5-10x

What type of scalying papular disease has a Christmas tree pattern in which patches on the back radiating down the spinal column A big patch seen in this is know as

Pityriasis Rosea Herald patch

hoke flatfoot correctio

Plantar base wedge athrodesis of navicular, 1st and 2nd cuneiform, TAL

miller flatfoot correction

Plantar base wedge of Navicula-1st cueniform and 1st cuneiform metatarsal fusion

structural vs positional HAV

Positional bunions= bone growth, Structural bunions= shifting out of position.

Root's theory for HAV: 5 main components for primary

Primary: Pathobiomechanics: compensation for -FF/RF varus/valgus, -equinus, -pronation (PL losingstabilizing pull), -MPE, -hypermobile 1st secondary: trauma/iatragenic, NM, RA

What are the ester local anesthetics?

Procaine, cocaine, benzocaine. Metabolized by plasma esterases. (All have only one "i")

Name several ways the body absorbs shock upon heel-strike

Pronation-dissipates shock calcaneal fat pad knee menisci knee flexion trabecular bone within calcaneus muscles vibrate

difference between proptosis and exopthalmos

Proptosis in the same reference is defined as exophthalmos. Proptosis can describe any organ that is displaced forward, while exophthalmos refers to only the eyes

micro bug that causes OM seen in durg addicts vs micro bug that causes OM seen in healthy adults and children

Pseudomonas vs S aureus

Ecthyma gangrenosum micro

Pseudomonas aeruginosa

phisiology of malignant hyperthermia

Pt is exposed the anestheic agent or muslce relaxant (SHID), the calcium stored in muscles are released causing muscles to fasciculate and contract. The rapid contraction causes muscle metabolism to be accelerated and causes a high fever, muscle breakdown, and acidosis.

bronchogenic carcinoma. digital clubbing, symmetrical arthritis, Linear periostitis (inflammation of periostium) of long bones: "Double strip sign" on bone scans, look like 2 cortices. Metaphyseal and diaphyseal

Pulmonary Hypertrophic Osteoarthropathy (PHO)

which class of drug has been known to cause Achilles tendon ruptures

Quinolones ciprofloxacin (Cipro), lomefloxacin (Maxaquin), norfloxacin (Noroxin), ofloxacin (Floxin), moxifloxacin (Avelox) levofloxacin (Levaquin)

Seropositive Arthritis (4)

RA SLE Active Hepatitis Sjogren's syndrome

Boutonnier deformity and swan neck vs Bouchards nodes and herberdens nodes

RA vs OA (DJD) M8, W171

Felty syndrome

RA, splenomegaly, neutropenia may present with pigmented spots on lower extremity and non healing ulcers

what does NCSP represent?

RF deformity

experimental, prospective study which subjects are assigned to a treatment or control group. Randomization ↓ bias and confounding. blinded (patient does not know to which group he/she is assigned) or double blinded (neither patient nor researcher knows the group assignment).

Random controlled clinical trial study

Fungal culture using a DTM (Dermatopyte test medium), requires 10 days to grow. what color does the medium have to turn to be diagnostic for dermatophytes?

Red

Bier block

Regional anesthesia in which the anesthetic agent is injected into a vein when there is a proximally located tourniquet

Heyman, Herndon, and Strong Procedure

Release of all the ST structures at Lisfranc joint *except lateral and plantar* ligaments

examples of comorbities contribute to wound failure in DM pts (5)

Renal failure Uncontrolled DM organ trasnplant anemia CHF

acidosis/alkalosis chart

Resiratory acidosis >40 Metabolic acidosis <40 Respiratory alkalosis<40 Metabolic alkalosis>40

logrocino bunionectomy

Reverdine + *Loison Balcescu* corrects IM and PASA

Limberg flap aka? V-Y plasty % distance increase?

Rhomboid: longitudinal axis is PARALLEL to line of minmal skin tension (pic) 20%

examples of supramalleolar AFO

Richie and Arizona

Most stable loop in cerclage? size range for cerclage wire?

Right angle loop most stable loop. 26 and 28

which is better for MA deformity rigid vs flexible

Rigid: low reoccurance rate

Rinne test vs Weber test

Rinne: vibration on mastoid to sound in same ear Weber: center of forhead

sievert

Roentgen dose equivalent

Indication for cocked up 5th toe

Ruiz-More

Lauge-hansen medial malleolar fractures?

SAD2 Vertical SER 4 transverse PAB1 Transverse PER1 transverse

steroid flare

SE from injectable steroid its a transient increased pain several hours after injection but goes away after 24hrs

propofol: SE? color? use? allergy?

SE=hypotensive effects on the heart, arteries, and venuels= so cant use it with bad heart condition color=milky white use=induction/maintainance allergy=egg

Triplane fracture

SH IV:

muscles of the rotator cuff

SITS Supraspinatus Infraspinatus Teres Minor Subscapularis

photosensitivity pericarditis nephritis

SLE

Extensor hoot apparatus WING and SLING

SLING: proximal WING: distal (plantar attachement of lumbrical)

SNEPPEN Classification

SNEPPEN - Talar Body Fractures Type 1 - OCD 2A - frontal shearing force 2B - sagittal shearing force 2C - transverse shearing force Type 3 - posterior tubercle Type 4 - lateral process Type 5 - crush

cardiac ischemia on EKG

ST segment depression and T wave inversion

Broca/Malgaigne classifcation

STJ dislocation 1. medial displacement 2. lateral displacement 3. Anterior/posterior displacement

Broden View is used to evaulate?

STJ posterior and middle facet

NCSP calcuation

STJNP + Tibial Influence

Samilson procedure? Grice procedure?

Samilson: sliding type calc osteotomy with lateral incision indicated for polio pt with very high CIA Grice: extraarticular STJ arthrodesis commonly used in CP

systemic granulation disease, unknown etiology, noncaseating granulomas. black females and Norwegians; target lung esp. age 30-40. tx with systemic steroid.

Sarcoidosis "Sarcasim=non serious"

Non-caseating granulomas vs caseating granulomas

Sarcoidosis vs TB

Lasegue's sign

Sciatica: pain with knee extened and hip flexed

Laségue test

Sciaticia: Straight leg raise produce symptoms

nerve injury classifications: (2)

Seddon classification sunderland classification

What makes up T1 vs T2 MRI on the long/short/ TE/TR graph.

Short TR <800 and short TE <30= TI long TR >800= balanced T2 TR (800). TE (30)

what does STIR stand for

Short-T1 Inversion Recovery (type of fat suppression used to nullify the signal from fat to allow greater visulaization of other tissues)

morton foot what is the difference between a metatarsal pad and a dancer pad

Shortening of the first metatarsal in relation to the second metatarsal -> brachymetarsia Excessive pronation of the foot, pain in the ball and arch of the foot w/ internal hip rotation and functional shortening of the leg tx: foot orthotics w/ metatarsal pad under the first toe and metatarsal to redistribute wt bearing to first toe difference: metatarsal pad offloads mets, dancer pad offloads 1st met

Tramadol SE

Similar to opioids. Decreases seizure threshold. Serotonin syndrome. (increased serotonin in CNS by inhibiting serotoinin reuptake)

HR increases with inspiration and decreases with expiration

Sinus arrhythmia

Schirmer test is for what? positive test?

Sjorgen's syndrome Litmus paper is placed on eye for 5 min, <5mm of wetness= positive schirmer test

a pt presents with a Long-term autoimmune disease that affects the body's moisture-producing glands. Primary symptoms are a dry mouth and dry eyes. Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, feeling tired, muscle and joint pains, and thyroid problems. A Schirmer test is performed to rule in/out?

Sjögren syndrome

this aquired from gradual compensaion of a metatarsus varus that develops with weight bearing or improper manipulation and castin

Skewfoot

Skin graft vs muscle graft

Skin graft contains vascular supply vs muscle graft contains vascular supply and muscle

A patient underwent surgery to correct rigid medially deviated second hammertoe deformity with long metatarsal. In what position should the toe be bandaged postoperatively to prevent complications?

Slightly plantarflexed because the toe will have a tendency to dorsally contract postoperatively.

Osteitis of Garre

Slow infection allow increase bone production and density to combat organism

3 Cerebral palsy types

Spasitc (70%) (most common) vs Athetoid (20%) vs Ataxic (10%)

Shown below is a radiograph of a 14-year-old male who fell six feet and presented to the emergency department two hours after the injury. Which of the following diagnostic tests is the most important to order?

Spine radiograph

Split thikness skin graft -thickness -encorporation -shrinkage -pigmentation/cosmetic appeal -susceptible to trauma -fail rate -cosmetic appeal

Split thikness skin graft: -epidermis/partial dermis, -increased SA, -increased drainage, -shrinks, -abnormal pigmentation, worse -more suseptible to trauma -lower fail rate

Koilonychia nail systemic pathology

Spoon nail, iron deficiency, inflammatory skin dx.

most common pathogen for fungal arthritis

Sporothrix shenckii

PAB ankle fracture (3)

Stage 1: eversion type of injury, there is a transverse avulsion fracture of the medial malleolus or rupture of the deltoid ligament Stage 2: rupture of AITFL and PITFL Stage 3: short oblique fibular fracture occurs at syndesmosis

PER ankle fracture (4)

Stage 1: transverse avulsion of medial malleolus or rupture of the deltoid ligament Stage 2: rupture of AITFL(Wagstaffe or Tillaux) Stage 3: high fibular fracture (maisonneuve Stage 4: rupture of the PITFL or a Volkmann's fx

Study with ages ranging between 3 to 64. How should it be documented?

Standard deviation and mode

Epidemiology definition

Stduy of incidence, distribution, and possible control of diseases and other factors relating to health.

which stewart classification is usally associated with peroneus brevis avulsion? aka

Stewart 3 (most common 5th met base fracture) aka pseudo-jones fracture

What is a Keith needle?

Straight needle

how are the branches of the superficial peroneal nerve?

Superficial peroneal n: IDCu and MDCu IDCu: LDCoDb, MDCoDb MDCu: DCoDb, DDb

Keck and Kelly osteotomy

Surgical treatment of Haglunds deformity W293

Emery-Dreifuss Muscular Dystrophy (EDMD)

Symptoms begin in teenage years with toe-walking, rigid spine, face weakness, hand weakness and calf hypertrophy. -shoulder and LE -bradycardia, palpitations -may need cane or walker

Pigmented villanodular synovitis in ankle on x ray

Synovitis of the Ankle with Extensive Bone Involvement

Superficial white onychomycosis caused by

T mentagropytes

Distal and proximal subungual onychomycosis caused by

T rubrum

Hypokalemia EKG

T waves flatten; U waves

most common dermatoyphyte infection causing tinea pedis

T. Rubrum "Rude bro you gave me tinea"

MRI fracture T1 vs T2

T1: decreased signal T2: increased signal

how quickley the transverse magnitization dcays is what type of MRI?

T2

only Topical steroid that causes vasocontriction

TAC: tetracaine, adrenaline, cocaine mainly used in dentistry

Tibial nerve blocks are most useful for (5)

TAL gastroc recession Achilles tendon tear repair clubfoot release pediatric pain manegment Mcglamery 67

Gastrosoleus equinus surgial procedure (-) silverskoid test ( cant pass perpendicular with knee flexion) vs Gastrocnemius equinus (+) silverskoid test (can pass perpendicular with knee flexion)

TAL (Z plasty, Hauser, White, Hoke, conrad frost) vs Gastric recession (vulpius, strayer, fulp and mcglammary, baker, silverskoid)

Best treatment to lenght heel cord with a negative silverskoid test

TAL becuase even with knee flexed where the gastroc could be the culprit, the AJ dorsiflexion doesnt improve, there for its an isolated achillies tendon problem, thus the TAL (negative test= cant AJ 0 degree with knee straight AJ 10 degrees with knee flexed)

Recently returned from Haiti and you have Haemophilus. What disease

TB

most common coalition

TC

gold standard for offloading a diabetic foot ucer

TCC

Pathology? FF adductus, RF varus, ankle equinus that creates skin folds. Congenital deformity with radiograph showing decreased Calcaneal inclinication angle Increased MAA, decreased Kite's angle. Talar headneck reletive to the body is increased addction and increased plantarflexion. Talus and calc almost parallel on Lateral. Order of casting for correction is: correct the Vavus deformtiy first then correctFF adductus then , RF varus,and then last cast out ankle equinus. -How is the cavus dermormity corrected in

TEV (club foot) taileps=talus + pes (CAVE=cavus, adduction,varus, equinus) correct the cavus deformity by supinating and dorsiflexing the 1st met to align with forefoot. common mistake is manipulatint the calcaneus (kites error) in that prevents abduction.

Girl with lower extremity weakness, 10 minutes of blindness, diagnosis?

TIA

Which joint if fused would cause the most decrease in motion?

TN

"aceabulum pedis" referes to what joint

TNJ

TNJ vs CCJ and Midtarsal joint axis relationship

TNJ: longitudinal (75,15,9) CCJ: Oblique (38,52,58)

Fracture classifications: Hawkin's? what is the canale view?

Talar neck fractures "hawks neck is fractured" modified AP with foot pronated 15 degrees to evaulate talar neck fractures.

what makes up the midtarsal joint

Talar-Navicular Calcaneal -Cuboid

club foot defomrity? Talus? Navicular? Forefoot? Rearfoot?

Talus= medial plantar diviation Navicular= medial subluxation Forefoot= adducted Rearfoot= varus and equinus

Difference between: Tc-99MAA vs Tc99MDP

Tc-99MAA: capillary bed fussion in DM, ascess healing potential in ishcemic ulcers "MAA is like MMA lots of blood" vs Tc99MDP: bone metabolism, stress fracture, osteoblastic

Best imaging for stress fractures (2)

Technetium 99 bone scan - may be positive 2-8 days after symptoms X-ray can take 14-21 days for bony callus

Tagged molecule is HMPAO for what type of bone scan? what does it stad for?

Technetium-99m Hexa-methyl-propylene-amine Oxime

Bridging therapy is basically the..... and is important to prevent..... How is bridging therapy done: 1. Stop _______? 2. Start ________? 3. Confirm______? 4. Restart ______? 5. Restart ______? 6. Discontinue ______?

Temporary administration of an anticoagulant, important to prevent clots 1. *Warfarin* 6 days preop if INR is 2-3 2. *LMWH* 36 hours after last dose warfarin 3. *INR* is will be between 1.2-1.5 at this point 4. *warfarin at regular dose* sx day 5. *LMWH* within 24hrs post op 6. *LMWH* 2-3 days post op until INR returns to therapeutic for 2 days in a row

Amputation: for total nail removal, removal of 1/2-1/3 distal terminal phalanx. Indicated for subungal, glomous tummor, mallet toe, macrodactyl

Terminal symes amputation M47

level of disease prevention: trying to improve your quality of life and reduce the symptoms of a disease you already have.

Tertiary

allen's test

Test for arterial blood flow, constrict artery of interest, press on skin, release artery and watch for color to return.

degree of frostbite: -may have months of erythema -subcutaneus layer -chronic edema and thawing recovery phases

Third degree

EKG dx: The atria and ventricles beat independantly of each other. Both the P waves and QRS complexes are present, although the P waves bear no relation to the QRS comples, atrial rate is faster than ventricular rate. treated by a pacemaker

Third degree heart block

raising the kVp will increase the negativity of the cathode and the negativity of the anode, which causes?

This willcause the electrons to hit the anode with a much *greater force*. The result will be an x-ray beam with a *greater penetrating power*.

Axial MRI of talar dome, which tendon is most anterormedial

Tib Anterior

Immediate branches of Sciatic nerve

Tibial Common Peroneal

Cardinal principles of radiation protection (3)

Time, distance, shielding

What is a PET scan used for?

To assess for cell death it shows the metabolic process in body. Helpful in cellular activity in cancer

rule of 15% lenghten scale of contrast (more shades of grey) vs shorten scale of contrast (less shades of grey)

To lengthen the scale of contrast Decrease the mA's by half and increase the kVp by 15% "increasing kVp increases GLAD PB" To shorten the scale of contrast Increase mA's by 2 and decrease the kVp by 15%

Hubscher Maneuver aka

Toe test of jack

Lopresti (Rowe 4&5) Tongue vs Joint depression

Tongue: vertical force continue vs Joint depression: the direction of the force is more oblique aiming posteroinferiorly

If orthotic has a c shape when casting, what does that mean?

Too much supination at stj

arthroesis planes of treatment transverse plane (2) frontal plane (1)

Transverse plane: self locking (Valleni, MBA), direct impact (Sgarlato mushroom, Pisani) Frontal plane: axis altering (STA peg)

describe the trifurcation of Extensor digitorum longus

Trifurcatin occurs at the head of proximal phalanx EDB attaches at the base of proximal phalanx 1 central slip inserts into the dorsum of base of middle phalanx 2 collateral slips unite at the head of middle phalanx and insert into the dorsum of the base of the distal phalanx

(T/F) The talus is wider anteriorly than posteriorly?

True

T:F Public health law requires disclosure of possible HIV infection to other sexual partners

True

T:F Steinmann Pinns and K wires can be threaded

True

T:F When muscles necrose they do not bleed when incised

True

T:F Epidural anesthesia should be considered over general anesthesia in pts who may be at risk for DVT and will be hospitalized for post op manegment

True Mcglammary 98

T:F Dermatophytes live on only dead cells? T:F Dermatophytosis infection elict an immune infection? T:F Dermatopytosis can become a systemic infection

True True False W245

T:F Its best to avoid surgery with CPRS pts

True treatments include: local anestheic inorder to do *aggressive PT* or massage, ROM exercise, US, splinting,contrast baths, TENS, acupuncture, nerve blocks, and psychotherapy. *AVOID SX* if at all possible

Angiolipoma

Tumor that contains numerous small blood vessels with fat

Stewart comminuted fracture is most likely which type

Tye 4 (Intra-articular

Tendonitis vs. Tendinosis

Type 1 collagen, inflammation, white glistening Type 3 collagen, degenerative, gral dull

cornate navicular aka

Type 3 lawson navicular ossicle

Salter-Harris Fracture: Oblique fracture through the epiphysis and metaphysis/diaphysis. Intra-articular

Type 4

Salter-Harris Fracture: Crush Injury of the growth plate which can cause shortening and is associated with poor prognosis

Type 5

Total homolateral incongruity

Type A Hardcastle

Lauge hansen relationship to Danis Weber: Type A (1)

Type A: SAD 1 Transverse avulsion fx of lateral malleolus at or below ankle.

Essex-Lopresti classification Type A vs B

Type A: Tongue fracture: talus is driven straight down into neutral triangle Type B: Joint Depression: vector of force is more anteroposterior (see pic with arrows anterior or posterior)

Partial Incongruity of 1st only (medial displacement)

Type B1 Hardcastle

Lauge hansen relationship to Danis Weber: Type B (2)

Type B: SER2, PAB3 Spiral fx of lateral malleolus at the level of tibial plafond (most common)

Lauge hansen relationship to Danis Weber: Type C (1)

Type C PER3 High fib fx, tibio-fibular syndesmosis rupture. (maisonneuve fracture)

Divergent partail with 1st displaced and 2,3,or4 mets displaced

Type C1 Hardcastle

Divergent total with 1st displaced and 2-5 dispalced

Type C2 Hardcastle

-Kuwada classification Type? -Treatment for each type? 23 y/o, ATR, 2cm defect

Type I: partail tear <50% (non operative) *Type II: <3 (end to end repair)* Type III: 3-6 (tendon transfer, graft) Type IV: >6 (gastroc recession)

Gustio and anderson with minimal to no periosteal striping

Type IIIA

Gustio and anderson with periosteal stripping

Type IIIB

Gustio and anderson with arterial injury

Type IIIC

Xray: if in calc occurs at the neutral triangle on xray may see fallen fragment sign. well defined lytic lesion w/out central mineralization MRI: huge white thing on T2 (hyperinesnse T2), hypointesne T1

UBC

increased leukocyte esterase

UTI

What is the difference between compensated and uncompensated equinus?

Uncompensated is usually congenital(Patient walks on toes, hypertrophic calves, STJ supinated, walking plantarflexed, smaller steppage gait, RF inverted) Compensated is when the patient overpronates to get more dorsiflexion at the midfoot.

fallen fragment sign

Unicameral Bone Cyst

Following the rule that all pts may possibly have HIV, Hep B etc is known as

Universal precautions

Kenzlee gets this type of rash with her mild allergy

Urticaria (hives)

Phonophoresis vs Ionotphoreses

Uses *ultrasound* to drive topical anesthetics, anti-inflammatories, muscle relaxants into tissues vs Uses direct *current* to drive topical anesthetics, anti-inflammatories, muscle relaxants into tissues

ASA class? -ruptured aortic aneyrism -cranial bleeding -massive trauma -sepsis syndrome with hemodynamic instability hypothermia

V (not expected to live witout operation)

PMMA drugs (3)

Vancomycin Aminoglycosides: (tobra, genta, ami,) Cephalosporins "VAC the PMMA drugs"

EKG Dx: A completely erratic rythm with no identifiable waves

Ventricular Fibrillation "VFib is eratic"

Hyperechoic in Ultrasound

Very bright on the picture or very echoic: bone, scar tissue, tendon, ligament, nerves, ulcer sinus tract

Hypoechoic in Ultrasound

Very dark on the picture or low echoic properties: muscle, ulcerations, inflammation, tendon teears

common peroneal nerve block location

Very superficial, 1-2 cm deep. Palpate fib head. *Enter 2.5 cm distal* to fib head. 3-6 cc of local.

why is joint sepsis not possible in kids ages 1-16 years old

Vessels do not penetrate the growth plate, and most joint sepsis is caused by hematogenous spread

Beau's lines

Visible depressions running across the width of the natural nail plate, often associated with *nail trauma*

classifications for DM (4)

Wagner Knighton University of Texas NPUAP Pressure ulcer

nerve sclerosing chemical neurolysis moa

Wallerian nerve degeneration via dehydration

Dermatofibrosarcoma protuberans

Well-differentiated, primary fibrosarcoma of the skin Slow growing, locally aggressive, rarely metastasize

Explain how a cavus foot type can have "pseudo"/osseous equinus

With cavus, the foot is more supinated. SO the talus will be more dorsiflexed and abducted. If the talus is already dorsiflexed, it does not have as much range of motion left for dorsiflexion at the ankle joint. So it can be considered pseudo equinus. The muscle itself isn't tight, it is the lack of motion at the joint.

40% hematoma under nail - drain vs nail avulsion vs 20% nail apparatus involved in an ingrown toenail

With hematomoc: avulse if >25% hematoma or fractured vs With nail involvement: <25 nothing, 50% drain, >50% avulse.

Why does overpronation cause secondary equinus?

With overpronation the calcaneus is everted, shortening the length of the achilles. With time this becomes contracted

Bundle of Kent aka and symtoms

Wolff-Parkinson-White syndrome: Symptoms can include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope

modification to austin that shortens and platarflexes met head

Youngswick modification

What is an injunction?

a court order ordering the defendant to do or not do a particular thing

What is a subpoena duces tecum?

a court summons ordering the recipient to appear before the court and produce documents or other tangible evidence for use at a hearing or trial.

Pitting Corrosion

a form of localized corrosion that creates pits form on metal surface

Triplane wede

a heel wedge thickest at its anteriormedial edg, sued to supinate the foot

talocrural angle? normal?

a line drawn parallel to tibial plafond second line dran tips of malleolus 83 +/-4

What is plasmapheresis?

a method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells, and transfusing the cells back into the bloodstream. It is performed especially to remove antibodies in treating autoimmune conditions.

implied contract

a pt presenting to be treated but payment is not discussed, the doctor is entitled to payment

delirium tremens.

a serious form of delirium due to *alcoholic withdrawal* after a period of sustained intoxication

define assault

a threat of physical harm

stress radiograph talar tilt what ligaments does it indicate injury if positive?

abnormal if tilt >10 degrees alone or >5 when compared to contralateral side aka stress inversion for ATFL and CFL

Ecrodactyly

absence of 2 or more rays "cleft foot" or "lobster foot"

Define phocomelia

absence of proximal limbs such as hand and feet attache directly to trunk.

reason to calculate true IM angle

account for metatarsus adductus becuase with a MA foot the IM look larger

which melanoma occurs most often on feet and hands, nails

acral lentiginous melanmoa if in nails, begins in proximal nail fold W256

the following symtoms describe: Severe fatigue. Unintentional weight loss. Gastrointestinal problems, such as nausea, vomiting and abdominal pain. Lightheadedness or fainting. Salt cravings. Muscle or joint pains. hyperpigmentation of skin labs: hypoglycemia anemia decreased Na and PB increased K decreased adrenocortical function

addison disease-decreased adrenocotical function

skew foot deformity: forefoot? hindfoot?

adducted forefoot valgus hindfoot

Pulled groin muscle

adductor due to forced abduction

General: Waterhouse-Frederichsen syndrome

adrenal insufficicney

All adult fx are _______ , only ped has ________ fx

adults: complete peds: incomplete or complete

Rheumatic fever

affects mitral valve most often "JONES" Joints, nodules, erythmea, Sydenham chorea -Aschoff bodies

MESS score categories (4)

age ischemia shock bone/ST injury

contraindiations for metformin (2)

age >80 serum cr <1.5 male or >1.4 female

neutropenia. aka

aka agrunlocytosis: deficiency of neutrophils

Definition of galvanic corrosion

aka dissimilar metal corrosion refers to corrosion damage induced when two dissimilar materials

Periungal fibroma aka

aka koenen tumor, seen around nail bed

what doe all these procedures hae in common? Addonte and Petrich and Dull Kelikian McKeever Brown

all are modifications to prevent toe retraction

increase in basophil and eosinophil

allergic reaction

normal values for NVC (nerve conduction velocity)

almost always >40 meters per second

Ionizing radiation

alpha, beta particles, gamma rays, xrays

define Monitored Anesthesia Care (MAC)

also known as conscious sedation or twilight sleep, is a type of sedation that is administered through an IV to make a patient sleepy and calm during a procedure. The patient is typically awake, but groggy, and are able to follow instructions as needed

what does all of these have in common: Ginger Biloba Ginseng Vit E garlic Fish oil

alter coagulation

Quinke's sign

alternating flushing and blanching of the nail bed d/t pulsation in the subpapillary arteriolar and venous plexuses->felt as capillary pulsation in the nail bed which can be encountered in aortic insufficiency

how does pericardial effusion appear on EKG

alternating height of QRS complex on all leads

make up of Unasyn

ampicillin/sulbactam

MESS score >7=

amputation

difference between anaphylactic reaction to the local anesthetic vs toxic reaction

anaphylatic reaction: -The lips & peri-orbital areas swell (angio-œdema) -agitated & there is generalised urticaria ('hives') & pruritus (itchiness), particularly of the hands & feet. -Other symptoms include abdominal cramps, nausea & diarrhœa Tightness of the chest, with wheezing & dyspnœa (difficulty in breathing) may occur -There may be a fall in blood pressure & a rapid thready pulse, which may be accompanied by flushing of the skin or rash. Toxic reaction: -drowsiness -tongue mouth paraethesia -Tinnitus, auditory hallucinations -muscular spasm -siezurre -coma -respiratory arrest -cardiac arrest

primary means of hemostatis during and after surgery

anatomic dissection technique

ganglion ultrasound

anechoic (black) well defined

Milkulicz angle aka

angle of inclination

Coxa Vara angle vs Coxa Valga angle normal for adult birth?

angle of inclinication <120 = coxa vara Angle of inclincation >130 = coxa valga (decreases fom birth 140) normal adult 120-130

Quigley Maneuver

ankle fracture reduction

cotton hook test

ankle mortise xray intraop, pull on fibula with clamp at level of syndesmosis and if there is no distraction=no syndesmotic inury 3-4mm lateral shift indicates syndesmotic instability

open pack position for ankle, 1st MTPJ, 2nd MTPJ

ankle: PF, 1st: DF, 2nd: PF

how often should OSHA exposure written plan be updated

annualy

calcanealnavicular coalition on lateral radiograph indicates?

anteather nose sign

CFL attachments

anterior border and apex of lateral mall to peroneal spine of lateral side of calc

forefoot varus compensation characteristics (4)

anterior break in cyma line Calcaneus is everted pronating foot forefoot on surface

compartemnt of leg m that is biphasic? (fires for both stane and swing of gait)

anterior compartment

Isherwood medial oblique position

anterior facet of STJ

Diffuse Idiopathic Skeletal Hyperostosis (DISH) most often affects which ligament in body

anterior longitudinal ligament

Shin Splint Causes (3)

anterior m overuse equinus lactic acid build up

shoe location: Vamp

anterior portion of the upper covering the forefoot and toes

nutation

anterior sacral tilt, posterior iliac tilt

exertional compartment syndrome most common compartments? (2)

anterior, lateral compartments

in vertical talus how are STJ facets deformed? hallmark?

anterior-absent middle-hypoplastic posterior-malformed pediatric deformity in which rigidty is the hallmark and it often occurs with athrogryposis

reverse thomas heel

anterolateral extension (rare)

3 most common portals

anteromedial anterolateral Posterior-Lateral

thomas heel

anteromedial extension made to the heel to provide additional support to the longitudinal arch and limit late midstance pronation

anteversion vs retroversion?

anteversion: femoral neck is anterior to the tanscondylar femoral axis= intoe. retroversion: out toe

reason for gentian violet (3)

antibacterial, antifungal, antihelminthec

Case with person experiencing fainting murmur?

aortic stenosis

atelectasis on Chest Xray

appears lighter than normal lung tissue. may be indicated by elevated diaphragm, mediastinal shift toward the area of atelectasis, or increased density and decreased volume of a lung area.

function of the whitman plate

applys pressure to the navicular with WB = *limit pronation*

Tc-99MDP use

areas of increased bone metabolism (fractures) and increased blood flow

symtoms other than GI for IBS (4)

arthritis Pyoderma gangreosum (treat with steroids). Violacious margins & lipodermatosclerosis ULCCCERS ulcers large intestine Contingous, Colorectal carinoma, Cryp abcess Exends proximally Red diarrhea Sclerosing cholangitis Vs Crohns

when to choose a hammertoe athroplasty over an arthrodesis

arthroplasty: reducible deformity arthrodesis: rigid

Reactive arthritis tetrad

arthrtis urethritis conjunctivitis mucocutaneous lesions

Fog on film. What does that mean?

artifact

how soon can a stress fracture be detected on a bone scan?

as early as 7 hours

when can a DMII take his regular insulin mediacations post op

as he can handle foot and water mcglamery 58

purpose for ASA guidlines

assess overal physcial health status preop

child has a cough after coming inside from being active outdoors indicitive for

asthma

flat line EKG aka T:F EKG is a poor indicator of ischemic heart disease

asystole TRUE

gait type for Werneky korsekov syndorome

ataxic

repetitive, involuntary, slow, sinous, writhig movements, especialy severe in hands? what conditions is it associated with?

athetosis seen in Huntington's disease, some with CP

HBO: atm? time? # dives? alternative?

atm: 2.4atm of 100% O2 time: 90 min # dives: 18-23 dives alternative: TCOM

DOC for celluitis that has E coli, Klebsiella, Pasteurella or Bacterodies

augmentin Medicine list

myasthenia gravis

autoimmune d/o affecting NMJ (-) ACh - long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. -Most commonly affected muscles are those of the eyes drooping, face, and swallowing. progressive weakness, women

Malignant hyperthermia has what kind of herditary

autosomal dominant

Peripheral neuropathy is damage to what part of the nervous system

axonal which causes sensory changes due to axaonal damage of small unmylinated nerves

where is the counter on a shoe

back 1/2 of upper touches heel

increased in monocytes and neutorphils

bacterial infection

difference between bard parker and beaver handle

bard parker for blades ranging from 9-25 beaver for blades ranging from 61-88, 312-316)

most common causes for myopathy (10)

barium swallow, autoimmune, endocrine, renal, alcohol abuse, steroids, retroviral meds, colchicine, PCP, heroin,

PEEK

basically plastic can be used in place of metal MRI ok, doesnt show up on xray

Rowe 2A

beack fracture (no achilles involvment)

Inverse square law radiology

beam intensity is inversilty proportional to the square of distance it travels (the further the beam progresses, the weaker the intensity)

what is dynamization in reference to External fixation

before ex fix is removed: all wires and pins are loosened and pt is allowed to weight bear to strenghten the bone and decrease fracture potential once ex fix is removed

single limb support described begins and terminates with?

begins with opposite foot toe off and terminates w opposite side heel strike

Where is spinal anesthesia injected?

below L2 to avoid spinal cord (L2-S1, L3-4, L4-5)

osteoid osteoma is malignant or benign? how to alleviate pain

benign. NSAIDS and asprin

POUR drugs (1)

bethanechol

Where does LPn run in foot

between 1st and 2nd layer

baxterns nerve travels where to innervate what m?

between abductor halluces and quadratus plantae and innervates abductor digiti minimi brevis. its the first branch off lateral plantar n.

Following a plantarflexion-adduction injury, a patient develops pain along the *anterior process of the calcaneus*. Dorsiflexion of the lesser toes against resistance is normal and without pain. The structure most likely involved is the

bifurcate lig

sulfonyurreas moa? 3 drugs?

bind to ATP dependant K+ channels on beta cells--> Calcium influx---> (+) insulin release -glyburide (2nd gen) -glipizide (2nd gen) -glimepiride (2nd gen) P72

if no change in venous statis ulcer size with unna boot or comprression in two months, what is next step

biopsy

Tibial varum: birth adults

birth: 5-10 adults: 2-3

MTA angle birth? 1 year age? 4 years age? Dx angle for Metatarsus adductus

birth? 25-30 1 year age? 20 4 years age? 15 (normal for adult) >20

Anechoic ultrasound

black fluid filed: ganglion cyst

__________study is the most appropriate and accurate research protocol for determining side effects of a medication

blind control

Color of nails pathology: blue: brown: Gray: Green: Red lunula: Yellow:

blue: antimalarial drugs, minocycline, hemochromatosis, wilson dz, silvernitrate brown: Addison dx hemochromatosis, gold therapy, arsenic, malignant melanoma, nelson synrome Gray: argyria (absorption of silver nitrate) Green: Psueomonas Red lunula: right side CHF Yellow: pulmonary dz and lymphedema

Charcot beaming of medial column - Purchase of screw through which aspect of the Talus?

body of the talus

bone healing strenght % vs tendon healing ____/5 strength

bone 100% tendon, looses one grade of strenth

what needs to be true to be considered a true AVN

bone death due to lack of blood flow (5) leg calf perthes Diaz Kohlers Freidburg Renandier and Trevor

T1 MRI image bone vs cortex

bone is white cortex is black

surgical repair for tendon rupture (3)

bosworth bugg and boyd lindholm

yu vs mann tailors bunion

both are 5th shaft medial oblique wedges to correct lateral IM angle yu-distal mann- proximal

use? Graston vs ASTYM which one is less painful? why?

both are instrument-assisted soft tissue mobiliziation Graston: breaks up scar tissue adhesions ASTYM: promtes scar tissue resorbtion (less painful)

Chronic Bronchitis vs/same Empysema

both are obstructive lung disease and both have decreased FEV1/FVC ratio -Productive cough for >3 months for <2 years vs -Exhlation through pursed lips to increase airway pressure and prevent airway collaps during respiration

Indium-111 use vs Gallium

both bind WBC Indium: acute infection vs Gallium: subacute and chronic infections

FEV1/FVC ratio for COPD vs Restrictive lung disease

both decreased. noral is 80%.

the sural artery (inferior muscular) supplies blood to (4)

both heads of gastrocs plantaris soleus

difference between short wave and microwave Diathermy

both heat tissues shortwave uses high frequency electromagnetic microwave use radiation

Fillauer Bar vs Dennis Brown bar

both treat same thing: -Metatarsus adductus -vertial talus -club foot originally difference: fillaure clamps to soles of pt feet while the dennis brown bar the shoe is attached to the bar

what defines sinus bracycardia vs tachycardia

brady <60 bpm tachy >100 bpm

Echogenic ultrasound

bright white image very dense object: bone US wave bounces back off bone

treatment for necrotizing fascitis (3)

broad spec abx Carbapenem or Beta lactam MRSA drug

Brodies abcess is often misdiagnosed as ostoid osteoma why?

brodies abcess a form of sub acute OM can be dormant for many years in which radiographically it takes the form of a radiolucent cavity surrounded by denes sclerotic bone and fibrous tissue

traumatic syndactyly most often occurs from

burns W441

plate used to protect from compression or axial loadig

butress pate

plate: protects bone that is unstable, and protects from compression or axial loading such as comminuted fractures or bone grafts. prevents shifts

buttressing plate

cadence vs speed

cadence= step/time speed= distance/time

which ossifiys first: talus or calcenus

calc

treatment of painful nerve endings include

capping the nerve silicone shielding covering nerve with muscle or vein placement of cut nerve into muscle belly or bone

safe bet closure suture

capsular closure (2-0 or 3-0 Vicryl) subcutaneous tissue (3-0 or 4-0 Vicryl) Skin (4-0 Nylon or Prolene)

purose for surgical instruments materials carbon chromium tungston carbide needle driver

carbon: hardness chromium: oxide layer protection tungston: extreme harness needle driver

Observational study where case (diseased) and control (non-diseased) are identified. ussualy a retrospective study where reserches look back in time to investigate disease or exposure, to evaluated risk factors

case control study (odds ratio is determined in both case control and cohort)

cat bite, dog bite, organism, tx

cat bite: pasteurella dog bite: strep viridans, Canimorus

long term non stochastic effects of radation

cataracts organ atrophy reduced fertility sterility

name the phsophate injectibles

celestone dexamethasone

which injectible is both acetate and phospate

celestone soluspsan (betamethasone)

make up of keflex

cephalexin

how can potential jurors be challanged

challanged for cuase or peremtorily

what causes joint pain in the winter

change in barometric pressure that changes joint synovial pressure causes pain

strain:

change in length divided by original lenght of given tissue due to stress applied

licked candy stick appearance describes what radiographic pathology

charco

indications for Intramedullary nail (5) positioning of the foot? too much reaming can cause?

charco arthropathy End stage PTTD Failed ankle implant Talar AVN postraumatic arthritis plantigrade, 0-5 valgus (same as in triple arthrodesis), 10-15 external rotation of foot osteocutaneous necrosis W363

why would WBC-labeled bone scan be helpful in distinguishing Charco from OM

charco is not an infected pathology

Diagnostic test for cystic fibrosis

chloride sweat test

Metformin and what other 2 DM drugs should be held preop

chloropramide and secretagogues

Located in talus or calcaneus Pain, swelling and tenderness Well defined, oval osteolytic lesion, eccentrically or centrally located Hemorrhagic foci, cystic blood spaces

chondroblastoma

Tumors composed of hyline cartilage

chondroma

scalloped margins indicate which bone tumor, well circumscibed,

chondromyxiod fibroma

brodies abcess aka

chornic OM or a form of sub acute OM which can be dormant for many years

Addisons disease

chronic disease of deficiency of aldosterone and cortisol production due to loss of gland function (opposite to cushing syndrome)

lawson's classification

classifys navicular ossicles

triad for Thromboangitis obliterans

claudication raynauds superfical thrombophlebitis

Antibiotic that is effected at penetrating the glycocalys around prosthetic imlants and is an effective alternative to cefzolin as a OR bacterial prophylaxis

clindamycin 600mg IV

Diagnosis for Muscular dysrophy (4)

clinical EMG muscle biopsy elevated CPK

if a pt with PAD cannot take asprin 81mg (first line of treatment), what is an alterantive anticoagulant

clopidegrel

when in podiatry are CAT scans used (3)? higher or lower radiation than MRI?

coalitions, complex fractures, charco foot higher radiation than MRI

when using contrast baths for muscle fatigue, edema, and RSD always start and stop with which bath

cold

Marfan sydrome

collegen defect makes people tall and slender. arachnodactyly, hyperextensibility, muscle mytonia, joint dislocation, sever pes planus, scolioss, lens subluxation, genu recurvatum, aorric dilation and aneurysm

draw out the sciatic nerve branches

common peroneal gives off deep peroneal and superficial peroneal the other side of common peroneal turns into LSC-->CRof LSC that joins with MSC which had branched from Tibial nerve

Diagnostic block for peroneal spasm?

common peroneal nerve

Nerve root for: common peroneal? Sciatic/Tibial? Femoral?

common peroneal: L4, L5, S1, S2 Sciatic/Tibial? L4,L5, S1,S2,S3 Femoral? L4, L3, L2 Draw the T12--> S4 chart from lower

purpose of cluffy wedge

commonly used in hallux limitus: holds hallux DF to promote resupination in flexible flat foot (mimics jacks test)

communicating vs perforating viens

communicating: superfical to superficial periforatiing: superfical to deep or vise versa

McGill pain index

compairs different diseases togeter like RSD/ CRPS is rated higher than chronic back pain

stress radiograph anterior drawer when compared to contralateral ankle

compare ATFL integrety to contralateral, >3mm is significant

what does RCSP represent

compensated at STJ

what is the first document filed in court for malpractice

complaint

atelectasis

complete or partial collapse of the entire lung or area (lobe) of the lung, most common issue with breathing after surgery

what is a stump neuroma

complication of neurectomy of mortons neuroma when the nerve tries to regenderate and forms bulb shaped stump, requireing same surgical treatment

what should occur before callus distraction of 1mm perday takes place

compress site for 7 days W366

Peroneus brevis vs longs on MRI? What is the main cause of this muscles longitudianl tendon tear?

compression by the peroneus longus on the peroneus brevis at the fibular ridge

plate: a plate with screw holes with sloped edges on the sie of the hole distal and from the fracture site. indicated when there is room for a lag screw

compression plate

plate in which the screw holes have sloped edges on the side of the hole distal from the fracture site

compression plate (prefer compression plate on transverse fx of 5th met shaft vs an intrameduarly screw if fx were a jones fracture.)

VTE prophylaxis for an active bleeding pt post op (4)

compression socks intermitant pneumatic compression devices venous foot pumps inferior vena cava filters

Russianing used in Exfix has what purpose

compression. the wire has a bow init

describe a kolionychia toenail

concave spoon

Clinodactyly

congenital curly toe

which calc fragment is the fragment to which all other fragments are fixed to, located at the sustentaculum tali which is the superiormeidal fragment

constant fragment

SE for opiods (4) most serious ?

constipation, urinary retention, nausea most seriorus: respiratory depression

Name the three parts that make up stance phase and %s

contact (27%) midstance (40%) propulsive (33%)

frankly infected aka

contaminated

when is an open fracture considered contaminated vs infected?

contaminated: treatment received within 6-8 hrs infected: treatment rceived >6-8 hrs injury

CT: Window width= contrast, smaller width, higher contrast Window level = density. CT number below window ______. CT number above window _____

contrast, smaller width, higher contrast density. CT number below window, black, white

ASA class III examples (8)

controlled CHF uncontrolled HTN uncontrolled DM History of MI, CVA, TIA COPD Stable Angina regular scheduled dialysis chronic renal failure

injury term: hip pointer

contusion of iliac crest

what method is being described? whirlpool or hydrotherapy

convection

Observational, where a cohort (subject spent time together) of exposed and non-exposed subjects are followed to see if dx develops. Usually prospective. calculates an odds ratio. calculates incidence, risk factors and prognosis

corhort studyd and case control

evans calcenal osteotomy

corrects flat foot in transverse plane

define passivation

corrosion *resistance* with oxide that is impervious to water and gas

tighter pitch designed for_____ screws higher pitch designed for ______ screws

cortical cancellous

General: cushing sydrome

cortisol increase

Laboratory tests prothrombin time measures how long it takes for blood to clot. _________ affects the physiological factors that prothrombin time measures.

coumadin

-creep definition? -metallosis definition?

creep: increase in strain when skin is in constant stress. occurs in minutes due to extrusion of fluid from dermis and a breakdown of dermal framework metallosis: *release of corrosion* debri and flaking into surrounding tissue

early sign of avn on xray

crescent sig: a subchondral fracture thorugh the insertion of the individual trabeculae

crystals within synovial fluid=

crystal-induced synovitis

whip maneuver

cuboid subluxation

Niacin SE

cutaneous flushing

eponychium

cuticle

what does bone marrow look like on T1 and T2 images

dark if normal is light, light if normal is dark

if an xray is over exposed it is

darker

how does acidity affect an anesthetic block

deactivates it

sequestrum

dead bone "S for Sick bone"

function of TP at contact (3)

decelerate STJ decelerate anterior tibia movement decelerate interal rotatio of tibia

decerebrate vs decorticate? what stage glasgow for each?

decerbrate (extension to pain Glasgow motor 2) deorticate (flexion to pain Glasgow motor 3)

Vitamin K does what to INR?

decrease (decreases the time to clot blood=clot quicker)

Digoxin chronotropic effect

decrease HR

stress relaxation

decrease in stress when skin is held in tension at a constant strain for a given time

what to do to kvp and mAs to increase contrast

decrease kvp increase mAs

club foot xray? Talo calcaneal angle calcaneal inclination talar/neck relative to body adduction plantarflexion

decreased Talo calcaneal angle decreased calcaneal inclination increaed talar/neck relative to body Increased adduction increased plantarflexion

why is Metformin held 24-48 hours before surgery

decreased renal function perioperatively cuases build up of metformin--> lactic acidosis metformin (-) lactic acid ability to enter gluconeogenic pathways in liver metformin (-) gluconeogenesis

Femoral neck version birth to adult aka femoral torsion, angle of antetorsion, angle of declincation

decreases: birth 30-40 adult 8-14

what is difficult to avoid cutting with a 1st metcunieform disection

deep perforating artery

When performing a Lapidus procedure for hallux abductovalgus, what structure should be avoided when exposing the first metatarsocuneiform articulation?

deep perforating artery.

Ehlers-Danlos syndrome

defects in collagen synthesis and structure; hyperelasticity

Plastic deformation

deformity exceeds the elasticity of the bone to recover so it cannot go back to normal bone shape due the damage to the cortex

False Claims Act:

defraud governmental programs, claim a doctor did a procedure without really doing it.

Increased chem lab indicates

dehydration

the process of falling out of sinc in MRI is called

dephasing

Breslow cancer stanging

depth in mm and % 10 year survival rate. <1mm 95-100% survival rate 1-2mm 80-96% survival rate 2-4mm 60-75 survival rate >4mm 50% survical rate

Herpes zoster which dermatome

dermatome: T7 (thoracic and trunk)

onychomycosis is most commonly infected by what

dermatophytes

where part of the bone does salmonella infect first

diaphysis

Wht are the Diastolic (5) vs systoilic murmurs ?

diastolic: "ARMS PRTS is PDA" Aortic Regurge, Pulmonary Regurge Mitral Stenosis, Tricuspid Stenosis also, PDA for systolic: flip the A with M, and P with T Mitral regurge, Tricuspid Regurge Aortic Stenosis, Pulmonary Stenosis, also MVP and VSD "the MVP has VSD" https://www.youtube.com/watch?v=sL0vHiXLZ-4 FA 279

how to give both Td and TIG at same time

different arms to avoid reaction

Brostrom-Gould

dir repair of ATFL with inferior extensor retinaculum reinforcement

use for Digoxin (3)

direct parasympathomimetic effects to treat: -atrial fibrillation -flutter, -certain arrythmias such as torsades

direct vs indirect reduction?

direct: open it up indirect: keep it closed

what is dissociative anetheisa what drug causes it

dissociative anetheisa (eyes remain open with slow nystamic gaze ketamine

Major SE for Ketamine (4)

dissociative anetheisa (eyes remain open with slow nystamic gaze unpleasand hallucinations fear and confusion cardiovascualar stimulation (arrythmias) SP204

joints affected in arthritis: distal IPJ vs MTPJ

distal IPJ: OA vs MTPJ: RA

which part of the femur is the last to fuse

distal femur (18-20 yrs)

-When doing a 5th derotational arthroplasty, the elliptical incision should be: - the more oblique= - the more longitudinal=

distal medial----> proximal lateral oblique=more transverse plane correction longitudinal= more frontal plane correction

most common location of heel pain in RA pts

distal plantar fascia

What would a dorsoplantar radiograph of the foot with a plantarflexed first ray taken in the angle and base of gait show the position of the hallucal sesamoids to be?

distal to the metatarsal head.

For the traditional Austin procedure to be modified to produce both shortening and plantarflexion of the capital fragment, how must the osteotomy be angulated?

distal-medial dorsal and proximal-lateral plantar.

derotational skin plasty for 5th digit

distal-medial to proximal lateral

what is the screw shank? what type of screw is the shank only found

distance between the head and the first thread. *Cancellous screws*

define stride lenght? average stride length?

distance between two consecuative contacts of same foot. (heel contact of one foot to heel contact of same foot) average stride length 4.5 feet

general class of medication to avoid with gout

diuretics (increase osmolarity)

what not to do when sending gouty tophi to the lab

do not send in formalin, it will dissolve the gouty tophi

Advantage of Crescentic bunionectomy

doesnt shorten metatarsal while correcting IM

The 2nd plantar interosseous deep/dorsal to the DTIL?

dorsal Interossiu (dorsal, 4th layer) DTML lumbrical (plantar, 2nd layer)

How many tarsometatarsal ligaments are there: dorsal? plantar? interossie?

dorsal: 8 plantar: 9 (8 + 1st cun to 3rd met) interossie: 3 (including liz franc)

Ankle joint motion in closed kinetic chain : forward motion? vs backward motion?

dorsflexion and abdut=appears inter rot of leg vs platnarflexion and adduct=appears ex rot of leg

positive babinski sign

dorsiflexion of the big toe and fanning of all toes

A patient presents with an acute dorsal dislocation of the third metatarsophalangeal articulation. Radiographs show no fractures and closed reduction is performed under local anesthetic. What is the proper sequence of maneuvers to reduce the dislocated digit?

dorsiflexion, longitudinal traction, and plantarflexion of the digit.

surgical correction for a coleman block test that results in the hindfoot becoming more rectus due the 1st ray becoming plantarflexed

dorsiflexory wedge osteotomy of the 1st met

causes for polydactly (4) most common vs least common

down syndrome lawrence-Moon-Biedl syndrome chondroectrodermal dysplasia trisomies 13,18 FH post axial most common central least common

post op for skin graft (4)

dressing remains 5-7 days, (2 days if meshing) elevate limb aspirate any fluid under graft eliminate shearing

Tibialis posterior tendon trasfer indication (2)

drop foot, recurrent club foot

Alginate use

drys out wounds (highly absorbant)

what does DEXA stand for

dual-energy x-ray absorptiometry

Turk test

dx tarsal tunnel sydrome caused by varicosities: test is positive with an inflatted tournaqeut and symtoms increase

Vinnete describing an older gentlement with the following will most likley have what? Dislocation of the joint. Heat. Insensitivity in the foot. Instability of the joint. Redness. Strong pulse. Swelling of the foot and ankle (caused by synovial fluid that leaks out of the joint capsule) Subluxation (misalignment of the bones that form a joint)

early signs for charco

why is marcain CI in childeren <12

effects growth plates

describe the primary lesion: plaque

elevated lesion >1cm

treatment for dermis statis ulcers (3)

elevation, diuretics, compression stocking.

CI for therapeutic ultrasound

embolic areas anesthitized skin epiphyseal area in kids bony prom DVT acute infection around metal implants pts with pacemakers

A 31-year-old female presents with a complaint of pain of the dorsal distal aspect of the hallux. Radiographs reveal a radiolucent area at the distal phalanx with surrounding sclerosis. There is no sign of infection, no sinus tract, and no edema. What is the clinical diagnosis?

enchondroma commonly found in proximal phalanx

Benign bone forming lesion, its technically a hamartoma (normal tissue in an abnormal loation) (bone island)

enostosis

santyl or other topicals that degrade eschar, protein and other nucleic agentes, which are reffered to as colagenase is what kind of debridement

enzymatic

Hemmoragic blister skin layer location

epidermal- dermal juntion

Avoid THIS DRUG in pts receiving Halothane, as it sensitizes the myocardium in the presences of exogenously administered doses.

epinephrine or any vasoconstrictors

Avoid compression across the _____ or _____ because it could create additional damage.

epipysis or physis

What is erysipelas vs cellulitis

erysipelas: actue *superfical* form of celluitis involving the dermal lymphatics. sharply demarcated, more of a systemic symtoms: fever and chills Cellulitis: deeper penetration into dermis and subq

Erythema nodosum vs erythema multiforme

erythema macles on shins, no central clearing, painful due to delayed hypersensitivity (type 4). is self limiting vs hands and feet, puritic, blanches*

oral tx for erythrasma

erythromycin or tetracycline W242

ester vs amide which has a higher allergy

ester

which IV anesthetic for induction doesnt have anlagesic properties and is useful in pt with comprimised myocardial contractility

etomidate (vs propofol which has SE of hypotension)

idiopathic thrombocytopenia skin? INR? Platelet? PTT?

excessive brusing and bleeding with normal inr, normal platelets, normal ptt?

symtoms of aortic stenosis? (3)

exertional angina exertional dysnea syncope.

difference betwen an expert and non expert whitness

expert: an give opinion non expert: only facts

sniffing when reffering intubation means?

extend the head and flex the neck. best postion for laryngoscope

shoe flange

extra stability on outside of shoe (medial for pronation and lateral for supination gait)

Deltoid ligament of the ankle is extrinsic or intrinsic

extrinsic just like the CFL

embryology reason for syndactly?

faiure of ectodermal ridge to stimulate the neccessary cell necrosis that leads to formation of interdigital clefts

T:F Osteoblastoma pain is relieved by aspirin

false

true or false: Partially threaded screws require an overdrill

false

T:F bicarb lab gives additional inforation on lung and/or breathing

false (assess Kidney function)

T:F a completley healed wound after an injury has skin tensile strenght of normal skin?

false (reaches 70-80% of normal skin)

T:F Hypermobility of 1st ray increases ROM

false is a mobility that shouldnt be there

T:F skin grafts can be placed directly over cortical bone or tendon

false (Recipeint site requires a vascular site)

T:F Parents can provide infomred consent for thier minor children

false: parents can provide informed permission

Neurfibromatosis (von recklinghausen dz)

familial condition affecting nervous system, muscles, bones and skin

fast or slow film/scree is safer for pt xray

fast

short term non stochastic effects of radiation (5)

fatique and skin changes nausea, bloody vomiting and diarrhea

DM ulcer smell: fecal vs Fruity

fecal- anaerobes vs Fruity-pseudomonas

what is medicaid

federal state program for poor, blind, disabled (medically needy)

fentyl vs morphine which is more potent

fentanyl is 100x more potent that morphine

Fibrous tissue develops in place of normal bone Pain, deformities, fx and nerve entrapment Scar like tissue

fibrous dysplasia

Ground glass appearance on X-ray

fibrous dysplasia causes bone swelling and expansion

bosworth fracture

fibular fx medial posterior

Eburnation def? seen in which arthritis?

final end bone product of sclerosis seen in OA

Gordon Sign? postive sign indicates?

firmly squeeze calf muscles results in extension of great toe (postive sign=UMN lesion)

What angle is a weil done at?

first cut: at least 30 degrees second cut: parallel to the WB surface

Degree of frostbite: -skin is pale initialy -but becomes erythematous and edematous with thaw -no blister or vesicle formation

first degree

-majority of PMMA beads leak Abx in what amount of time? -when should they be removed? -Studies have shown leakage upto ___years post application

first few hours to days -removed 2-4 weeks later, or else after all the Abx have leaked out, the bead becomes a source of bacteria up to 5 years

double hump curve, where is TP vs TN, best hump for sensitivity vs specificity

first hump: TN and sensitivity second hump: TP and specificity

Which radiographic finding is most important in evaluating placement of an osteotomy for correction of hallux valgus?

first intermetatarsal angle.

stage of CPRS: pain, burning and swelling for 1-3 months

first stage: inflammatory or acute

difference between flare and flange on shoe

flare increases width of shoe flange stabilizes side of shoe

describe the primary lesion: patch

flat >1cm non fluid filled lesion

negative Hubscher Maneuver test

flat foot is rigid

If the after the coleman block test the 1st metatarsal plantarflexes and the rearfoot becomes more rectus

flexible rearfoot varus

Indications for STATT? (3)

flexible rearfoot varus too much supination dorsiflexory weakness

Gigli saw

flexible wire saw

Which of the three theories describes this type of hammertoe? TAL was done->achilles does not have enough plantarflexion->FDL over fires and over powers intrinsics. hypermobility occurs

flexor stabilization

porta pedis floor and roof

floor: AbH roof: QP

determining skin flap viability?

fluorescein dye study. It is an accurate predictor even at 18 hours post injury

main goal for midstance? how is midstance defined

foot to become rigid lever. opposite side toe off to heel lift of support foot

stress

force applied over a crossectional area "streSS croSSesctional"

Nutcracker sign vs Nutcracker syndrome

forced plantarflexion at AJ elicits pain for shepherd's fx vs Navicular fractures 1: Tuberosity fx: PT tendon avulsion-nutcracker syndrome *2: Dorsal lip fx: most common* 3a: Nondisplaced body fx, 3b: Displaced body fx. 4: stress fx. intraarticular,

fully compensated equinus gait (4)

forefoot supinatus STJ pronation Heel valgus HAV deformity (most pathologic)

degree of frostbite: -full thickness -gangrene tissues -need to wait for demarcation of gangrene before amputation

fourth degree

neurolysis

freeing a nerve from adhesions

Key Crego Mcglammary Langenbeck Freer Sayre

freer elevators

DKA symtoms (8)

frequent urination. extreme thirst. high blood sugar levels. high levels of ketones in the urine. nausea or vomiting. abdominal pain. confusion. fruity-smelling breath

blunt tip needle used for

friable tissues like kidney and liver

-disease of spinal cord and Periperhal nerve degenration. -pts develope soliois and need back surger -awkward unstead gait -doesnt affect cognitive function -affects heart to pump at capacity -symtoms occur between 5-15 years old -pts are confined to a wheelchair 10-20 years after onset

friedriech ataxia

where is the Vamp on a shoe

front 1/2 of upper

Plantar fibroma ultrasound

fuisform shaped, heterogenous, hypoecjoic (dark) mass next to plantar fascia

NCSP 6, RCSP 0 =

fully compensated

orthotic type that posting is used only

functional

difference between functional and accomodative orthotics?

functional: foot takes shape of orthotic accomodative: orthoic takes shape of foot

most common pathogenic fungi affecting human is

fungi imperfecti

Patient with shortness of breath. 4 plus pitting edema. What would be most helpful in treating his SOB?

furosimide

Infected hair follicle

furuncle aka boil (Carbuncle is multiple furuncles) "multiple cars" staph a

what are the stance phase muslces (4) vs swing phase muscles

gastroc soleus FHL FDL TP? anterior tibialis EHL EDL PT,PL,PB all intrinsic

TAL vs Recession for positive silverskoid with knee flexed and extended

gastroc recession

Tendon healing process 4 weeks worth

general inflammation week 1: severed ends fill with granuation tissue week 2-3: increases paratenon vascularity, collagen fibril alignment week4: return to full activity w/o immobilization

what is atrophie blanche

generally occurs after chronic statis dermatitis and or statis uleration, presents with white plaques of sclerosis, hyperpigmentation

atopy

genetic tendency to develop an allergic disease such as asthma.

Person with increased plantar heel pad thickness,

giantism

A 43-year-old male with Addison's disease of 20 years duration is on a maintenance dose of 30 mg. hydrocortisone per day. Prior to surgery, how should this patient be treated?

give a stress dose of glucocorticoids (100 mg hydrocortisone phosphate IV q 24 hr)

Trendelenburg muscle weakness? innervation?

gluteus medius (inervated by superior gluteal n)

cause of equinus in DMII

glycosilation of collagen in achillis tendon cuases it to become tight (glucose is trapped and causes the tightness). tight achilles causes lack of dorsiflexion in gait causing exccess plantar pressures

grades of sprain and treatment (3)

grade 1: rest, protect, reduce swelling, grade 2: restore ROM, strenght, flexibility grade 3: avoid twist, turn, sudden or sharp turns. gradual return to play. Surgical repair= rare (indicated with continued pain)

what entity is issuded an inditctment? is the accusted present?

grand jury and the accused is absent

When is open reduction is recommended for Lisfranc injuries?

greater than 2 mm.

MRI of muscle belly axial

grey

Erysipelas micro bug

group A strep (strep pyogenes) "red mitten on baker #1 demonstrates well demarcated border red lesions

Drato, Oloff and Jacob Classification (4 stages)

hallux limitus: stage 1: functional stage 2: stuctural adaptation pain stage 3: joint destruction stage 4: ankylosis

coughlin and shernas classification?

halux rigidus. *grade 0*: 40-60 degrees DF, normal xray, no pain. *grade 1:* 30-40 degrees DF, dorsal osteophyes, mild pain. *grade 2* 10-30 degrees DF, narrowed joint space, more pain. *grade 3* <10 degrees DF, constant pain end ROM. *grade 4* < 10 degrees DF, pain mid ROM

hammer toe vs claw toe vs mallet toe

hammer toe: DF MPJ, PF PIPJ, Ex DIPJ claw: DF MPJ, PF PIPJ and DIPJ mallet toe: PF DIPJ

scleroderma

hardening of the skin

Hubscher Maneuver tests

have the pt stand WB, grastp the hallux and passibly dorsiflext it if this creats an arch then the flat foot is *flexible* (This is a positive Test)

Herbert screw

headless, 2 threaded sections separate by a smooth section, can be used across articular surface-OCD repair

insertion for flexor hallucis brevis

heads unite and insert base of proximal hallux

what is congestive heart failure

heart is unable to pump sufficiently to maintain blood flow to meet the body's needs symtoms include: shortness of breath, excessive tiredness, and leg swelling.

best way to test the heart?

heart stress test

axial sesamoid foot position

heel raised on horizontal plate

Multistick needle catheterization

helps rule in/out compartment syndrome

xanthrochromia association

hemmoragic synovial fluid

what can cause a false elevation when determining hyperkalemia

hemolysis

Muffucci's disease

hereditary multple endochondromaatosis with ST telangiectases (100% malignant)

pizeogenic papules

herniations of the fat pad into the dermis

best combo for ideal xray: kvp: mAs: exposure time

high kVp low mA short exposure time

does bupivicane, tertacaine, and procaine have a high or low pkA

high=slower onset (8.1-8.6 pKa)

Talipes Calcaneovalgus

hindfoot eversion and dorsiflexion

Popliteal block location

hits the sciatic nerve (posterior knee about 7cm proximal and 1 cm lateral to transverse popliteal crease) need to also inject at the saphenous n

Stent dressing use

holds skin graft in place

Thiazide SE

hyperGLUC" Hyper-glycemia, Hyperlipidemia (cholesterolemia), Hyperuricemia, Hypercalcemia Sulfa Hypokalemic metabolic alkalosis

mortons neuroma on ultrasound

hyperchoic due to its density. (AMPLE practice questions)

wooden objects on ultrasound

hyperchoic with a hypoechoic dark shadow

cholesterol is increased in what pathologies (5)

hypercholesteremia biliary obstruction hypothyroidism enphrosis DM W326

normal tendon on ultrasound

hyperechoic

Ehlers-Danlos syndrome clinical exam (3/5)

hyperelasticicty, flat feet, genu valgus, congenital hip dislocation, scoliosis

affects of Steroids (6)

hyperglycemia Anti Inflammatory Immune supression Decrease collage formation (tendon rupture) Decrease bone formation (osteoporosis) Decrease granulation (keloid break down)

what general diagnosis can cause the following? Polydypsia, polyuria, weakness, lethargy, organ calcification, kidney stone, ostoclastic giant cell. Brown tumor (bone cyst). Subperiosteal bone resorption!, acroosteolysis. Chondrocalcinosis. Increase alkaline phosphatase

hyperparathyroidism

a scar that results in unchecked proliferation of the fibrous tissue following an injury to the skin and remains confined to the site of the original site of injury

hypertrophic scar pic vs (keloid scar that invades surrounding tissue, has increased histamine, well demarkated)

Tendinosis and tendon tears ultrasound

hypoechic (dark)

SE for sulfonylureas (2)

hypoglycemia, weight gain

SE of furosimide (5)

hypokalemia exacerbate HF interstitial nephritis hyperurecemia contraction alkalosis

3 main causes for osborn waves aka J-wave on EKG?

hypothermia, hypercalcemia, MI

General: Subacute *thyroiditis*

hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel *thyroiditis* -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens

General: Riedel thyroidisits

hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens

General: Hashimoto thyroditis

hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens

General: Cretinsim

hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens

General: Wolf-Chaikoff effect

hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens

TSH >10 indicates? increased serum creatine kinase is associated with hypo vs hyper?

hypothyroidism hypothyroidism

what are the levels of evidence from I-6 what is the higest level of eveidence? which is higher case control or case series?

i META SYSter, RANDOM CO/CASE. 1. meta analysis 2. systemic review 3. randomized controlled trials 4. cohort and case control studies 4. case series and reports 5: ideas/opinions/ editorials

quasi-contract (implied-in-law contract)

if a physician treats an victim, he or she cannot get sued if caused a harm to the victim during the process.

when would a civil malpractice case be tried in a united states district court? (2)

if citizens are from differing states and matter of question is >75,000$

when will a mal practice be presented in front of a jury

if either party demands it

when is a doctor liable for "bad results" on a case?

if he promised or guarenteed a result that was not achieved

When a hospital denies staff privileges to a doctor, what are the doctor's legal rights?

impartial hearing which is reviewable by the court

purpose for kirby's skive

improve supination by creating a varus wedge

positively vs negativley skewed data graphs

in skwed graphs, the more reliable data point is the median rather than mean. positively skewed: right squewed- mean > median negatively skewed: left squewed- mean < median

preferred method of treatment of burns inpatint vs outpatient

in-pt: open= topicals applied w/out dressings out-pt: closed=topicals applied w dressings

positive stemmer sign

inability to pinch the dorsal aspect of the skin between 1st and 2nd digits (may be cuased by lymphadema). *positive sign is inability*

where does MPn run in foot

inbetween FDB and AbH

Warfarin does what to INR

increase (increased INR=increased time to clot)

what to do to kvp and mAs to: increase density

increase both

how to change mAs with dry fiberglass

increase by 40%

how to change mAs with wet fiberglass

increase by 60%

Digoxin ionotropic effect

increase contractility

purose of a shoe flare

increase width of shoe for instability

pheochromocytoma? symptoms?

increased catecholamines due to catecholamine secreting tumor (chromaffin cells) in adrenal medulla. symtoms: HA, sweating, tachycardia

Neurovascular theory: charco

increased peripheral blood flow from autonmic neuropathy leads to bone resorption

why avoid tourniquet with sickle cell pts (3)

increased risk of local acidosis hypoxia venous stasis

excess thermal energy from a bone saw or drill can cause damage to bone how

increased zone of resorption at the osteotomy site

calcaneocuboid angle is changed how in skewfoot? hallmark?

increased. hallmark is lateral subluxation of navicular on the talar head.

parathyroid hormone function

increases blood calcium

Hydrogels use

indciated for dry wounds to rehydrate them

common complications for ankle arthroscopy (5)

infection nerve injury vascular complications reflex sympathetic dystrophy synovial fistulas

for heat therapy t be beneficial what phase of healing needs to be done with

inflammation phase

most common loccation for aortic, femoral and popliteal aneurysm

infrarenal aorta

Gabapentin MOA

inhibits: AA and GABA (gamma aminobutyric acid)

what causes calcaneal apopysitis (sever's disease)? -recall the secondary center of ossification post calc? -age of kid/gold standard for treatment?

innflammation of the seconary center of ossification center of calcaneus (4-10yr) due to traction apopysitis and repetative microtrauma seen in children. 8-14 years old is average age of occurance. / gold standard for treatment is short leg cast immobilization for 2-4 weeks (BV) or orthotics (AMPLE)

difference between medical malpractice being civil or criminal

intent

lateral talocalcaneal angle? increased or decreased with flatfoot?

intersection of the line bisecting the talus with the line along the axis of the calcaneus on lateral weight-bearing views. *>45 degrees =hindfoot valgus, component of pes planus*

what is the relationship between: mAs vs kVp

inverse mAs: quantity of x-ray emitance "A for dArkness Amount, Quantity" how dark the scales are. kVp: controls contrast or grey scale (quality) "V for Visualize the grey, contrast for better quality" W198

mech of injur for anterior process of calc? most common cause of this injury

inversion and plantarflexion. wearing heels

Sinus Tarsi syndrome occurs most often when

inversion sprain

medial calcaneal osteotomy for flat foot surgery affects the achilles how

inverter of subtalar joint

Involucrum

invo*l*ucrom: new/living bone growth around a sequestrum "L for living bone"

animal bite, irrigate with

irrigate with 1% benzalkonium chloride

thrombocythemia.

is a disorder in which excess platelets are produced, leading to abnormal blood clotting or bleeding.

Young's modulus

is a measure of the ability of a material to withstand changes in length when under lengthwise tension or compression. Sometimes referred to as the modulus of elasticity, Young's modulus is equal to the longitudinal stress divided by the strain.

polycythemia vera.

is a slow-growing blood cancer in which your bone marrow makes too many red blood cells.

verrucous carcinoma.

is an uncommon variant of squamous cell carcinoma -seen in those who chew tobacco or use snuff orally aka "Snuff dipper's cancer." -also seen in mounth but can be on foot also

Contraction at a constant velocity at all ranges of motion by using a machine with an accommodating resistance

isokinetic

muscle contraction not associated with joint motion or change in muscles lenght. can be preformed in cast (plank)

isometric

neutrophillia is highly associated with

joint sepsis

If the radiograph is over exposed (image is too dark), what do you need to lower?

kVp and mAs

If one desires an even lighter radiograph to evaluate soft tissue, what should be done to the kVp

kVp can be decreased

treatment of choice for psorisasis (4)

keratolytics topical corticosteroids sunlight donovex (Vitamin D) W248

Reiter's disease derm finding

keratosis blennorrhagica

which provides analgesic: propofol etomidate ketamine benzodiazepine

ketamine

Prerenal azotemia is caused by

kideny hypoperfusion (w/o kidney disease) hemorrhage, shock, volume depletion, congestive heart failure, adrenal insufficiency, and narrowing of the renal artery among other things.

Heavy NSAID use not only damages stomach but can have an effect on what other organ

kidney

what organs are damaged if compartment sydrome isnt treated

kidney and nerves

organ status for hyper/hyponatremia

kidney function

specific gravity measures? normal? what pathology is it deceased in?

kidneys ability to concentrate urine normal: 1.003-1.035 decreased only in Diabetis Insipidus. Every other pathology mentioned is increased

kinematics vs kinetics

kinematic: study of motion vs kinetic: study of mass, force, momentum

most common location for septic arthrits

knee

Legg-Calvé-Perthes disease symptoms

knee (hip pathology can refer pain to a normal knee), or groin pain, exacerbated by hip or leg movement, especially internal hip rotation (with the knee flexed 90°, twisting the lower leg away from the center of the body). -reduced ROM, particularly in abduction and internal rotation, and the patient presents with a limp. Pain is usually mild

Contraindication for arthroereisis (4)

knee angular deformity tibial torsion metatarsus adductus Valgus ankle

Coxa Vara causes what more distally

knocked knees genu valgum *b*

If the radiograph is underexposed (image is washed out) what do you need to raise?

kvp and mAs

Flexor retinaculum aka

laciniate ligament

why should lacted ringers be avoided in DM pts

lactate can be converted to glucose

Which fluid contains K?

lactated ringers

Plantar fibromatosis aka

ladderhose disease, seen in plantar fasicia

Contraindications for bone stim (5)

large defect (>1cm) or >1/2 diameter) pathological fx, bone cancer, pregnancy, pacemaker.

type III lawson

largest navicular ossicle that is near talar head, may be fused

xray for an achilles tendon enthesis? what is an enthesis

lateral WB. where the tendon attaches to a bone, it can beome inflamed.

insertion for quadratus plante

lateral aspect of FDL

insertion for adductor hallucis

lateral base of proximal hallux

insertion of Abdutor digiti minimi

lateral base of proximal phalanx

What cueiform is not visible on a cavus foot on AP xray?

lateral cunieform

Tailors bunion block nerves

lateral dorsal cutaneus 4th common dorsal digital n superficial br of lateral plantar n 4th common plantar digital n

lateral flare use

lateral instability inversion sprains

Lateral ankle projection, where should the beam be aimed

lateral malleolus

best view to view os tibiale externum

lateral oblique

best radio to view CN bar

lateral oblique projection aka medial oblique view

A 21- year- old female presents with pain and swelling to the right ankle. The patient states that last week she jumped from a high fence on to uneven ground, twisted her foot and fell forward. Assuming that the foot was inverted and then forced into dorsiflexion, this type of trauma would suggest what type of frequently missed fracture?

lateral process of the talus

anterior-central portal

lateral to EHL, medial to EDL

Dermatomes of lateral, middle, medial foot

lateral: S1 middle L5 (4,3,2,1/2 of 1) medial: L4 (1/2 of 1)

Transverse banding

lead poisoning

patterns of bone destruction (3) which is least to most aggressive

least to most aggressive "alphabetical gmp" geographic moth eaten permeative

postion to put pt in when doing a right lateral ankle repair

left lateral decubitus

capsulotomie that corrects in both transverese and frontal plane (2)

lenticular Washington monument

which melanoma occurs most often on the face and is basically a malignant freckle

lentigo maligna melanoma W256

Predislocation syn

lesser MPJ instability

Wickam's striae: lace pattern white line. Flexor surface, Koebner phenomenon. Pitting nail, onycholysis, planar, polygonal, purple, pruritis Treatment?

lichen planus topical corticosteroids and intralesional corticosteroids

Lisfranc ligament anatomy? "Fleck sign" on Xray

ligament: 2nd metatarsal to 1st cuneiform Fleck sign: Avulsion of the Lisfranc ligament (at the base of the 2nd metatarsal)

difference between hallux limits and rigidus, difference between orthotic modifications

limitus: 1st MTP limitation w/o DJD (reverse Morton's extension) Rigitus: 1st MTP limitation w/DJD (Morton's Extension)

Inverted champagne bottle appearance

lipodematosclerosis

Best way to remove a skin tag

liquid nitrogen occurs more in obese, more with age

Colon CA will most likely metastasize to?

liver

Mostimportantsiteofdrugmetabolism

liver

Where are NSAIDS metabolized?

liver

amide are metabolized where? excreted where

liver kidney

Billirubin found in urine indicates damage to what organ?vsprotien

liver damage

why is spinal anestheisa not used with liver disease pts

liver disease cant make clotting factors=higher risk of spinal bleeding

most common joint affected in Charco

lizfranc

STJ neutral position puts the MTJ in ______ position?

locking

plate: plates that have screws that secure to the plate, prevending togle and providing more stable fixation, they make good bridge plates as they act like an interal external fixatior

locking plate

short wave incsion method (SWIM) is best used for

long or irregular hypertrophic scars

xray: long scale vs short scale

long scale: lots of grey short scale: very black and white

Leads on an EKG representation? where to look for an MI?: septal: posterior: anterior: lateral: inferior:

look at anterior inferior EKG. septal: V1,V2 posterior: V1, V2 anterior: V2-V5 lateral: 1, aVL, V5, V6 inferior: II,III, aVF

lower motor neuron lesions symptoms

loss of voluntary control, decreased muscle tone, flaccid muscle paralysis, muscle atrophy, absent or decreased reflexes negative babinski

upper motor neuron lesions symtoms

loss of voluntary control, increased muscle tone, muscle spasticity, no muscle atrophy, hyperactive and abnormal reflexes positive babinski (bad)=toes fan out when stroked

low plane axis= ? dominance. high lane axis= ? dominance

low plane=frontal plane dominence high plane=transverse plane dominence

does lidocaine, prilocaine, etidiocaine have a high or low pKa`

low=faster onset (7.7-7.8 pKa)

what causes erythema migrans

lymes disease

Which directly controls amount of xrays

mAs

Which is the primary control of optic density? mAs vs kVp

mAs

decrease ____ for elderly radio

mAs by 30%

primary lesion name for freckle

macule (flat <1cm)

size difference between patch, macule, plaque

macule <1cm, flat patch >1 cm, flat plaque >1cm, raised

hydrocolloid use

maintain moist wound environment while absorbing excess drainage

In using a Z-plasty to correct a skin contracture, what should the surgeon do?

make the central incision of the Z parallel to the contracted skin.

laryngeal mask airway

makes intubation easier

Russian Stimulation

makes muscles contract through full range of motion

multiple myeloma def

malignant tumor of bone marrow cells

most common malignant bone tumor most common benign bone tumor

malignant: *osteosarcoma* (Multiple) myeloma is more common but is concidered a marrow cell tumor vs a bone tumor) benign: *Osteochondroma* (pic)

Angle and Base of Gait: malleoli? foot abduction from midline?

malleoli are 5 cm apart, foot abducted ~13 degree from mid line.

ossifying fibroma is most commonly found where

mandible

vodder treatment

manual treatment for decongestive therapy of lymphangitis

met head resection with a soft tissue flap between 1st met and proximal phalanx to avoid bone on bone

many-heuter

Roentgen (R):

measurement of radiation

what kind of displacment calcaneal osteotomy to correct flat foot surgery

medial (shifting calcaneal tuber medialy)

what are the 9 compartments of the foot in danger or compartment syndrome

medial lateral superficial interossie x 4 adductor Quadratus Plantae W497

the dorsal cutaneus nerve innervates:

medial 3rd and lateral 2nd

insertion for abductor hallucis

medial base of proximal phalanx

difference between a medial buttress and medial flare modification

medial buttress: external medial flare

meuller classification

medial mal fractures A: avulsion B: transverse at ankle mortis C: Oblique D: near vertical

best view for os calcandues secondarius

medial oblique

Best view to see a CN coalition

medial oblique view

best view to view CN

medial oblique view

Isertion of Dorsal Interossei

medial or lateral side of base of proximal phalanx

Insertion of Plantar Interossei

medial side of base of proximal phalanx

Patient/ runner with tibial pain. Tibia lights up on 3rd phase of bone scan.

medial tibial stress syndrome

posterior-central portal

medial to achilles lateral to tarsal canal HIGH RISK

The relaxed skin tension lines on the sole of the foot from?

medial to lateral

The vomiting center of the brain is located in the reticular formation of the ________

medulla

wet to dry dressing or hydrotherapy is what kind of debridement

mehcanical

candel wax appearance in bone with sclerosis in the peripheray

melorheostasis

This drug can be used to control shivering in OR

meperidine (Class II drug)

what is the major soruce of vascularity to the tendon

mesotenon

Where does plantar plate rupture off of?

met head

which type of blood chemisty do you need to check the anion gap

metabolic acidosis

pH <7.35, PCo2 <40

metabolic acidosis (check anion gap)

best location to transect the shaft of met for a distraction? why (3)

metaphyseal, better vascularity and osteogenic potential, greater SA=better strenghth and stability. although its much more difficult to get to.

indiciation for youngswick modification?

metatarsus elevatus (modification to austin that shortens and platarflexes met head)

alternatice acute gout flare medication if pt already has GI ulcers and cant take indomethacin

methylprednisolon

most common IV benzodiazepines used (3)

midazolam, versed, valium

most common vessel involved in a stroke

middle cerebral artery

most common talocalcaneal coalition

middle facet

Isherwood medial Oblique Axial position

middle facet of STJ

TENS moa

mild continuous electrical current into skins which blocks pain signals and stimualtes endorphins

what circumstances can staute of limitations be extenede

minor out of state doc doctor conceals pt true condition pt didnt promptly discover ture conidtion

Period between forefoot loading and heel off

mistance 40% of stance" flexor stabilization (pronated foot and aductovarus of 4th and 5th toes)

hosystic murmur

mitral regurge

Mid-systolic click

mitral valve prolapse

Parkinson's disease: moa: symptoms:

moa: cell death in basal ganglia causing not enough dopamine to brain -Asymmetric, resting hand tremor (MC presenting feature) -Akinesia (slow movement, except in emergency) -Postural instability -Shuffling gait with lack of arm swing -Fixed facial expression -Quiet voice -Cogwheel rigidity -Myerson sign (Glabellar relex) = sustained blink response when tapping over bridge of nose -Palmomental reflex = scratching palm causes chin to tense -Dimentia in later stages NO muscle weakness Normal DTRs

which sutre has a longer 50% tensile strenght: monocryl or vicryl

monocryl: 2 weeks vicryl: 3 weeks (is at 75% strenght by 2 weeks)

Non-stochastic

more certain threshold linear safe doses of radation can be reached

what opiates are derived from the poppy plant? (4)

morphine, opium, heroin, and codeine

Talocalcaneal coalition on xray: lateral (6), AP (1) -ages 12-14,pain in sinus tarsi over middle facet decreased STJ ROM

mostly seen on lateral xray -C sign or halo sign -Absent of STJ -Talar beak sign -rounded of lateral talar process -shortening of talar neck -shortening of posterior facet -ball n socket of ankle mortis (AP)

most common cause of delayed union

motion

-6mm MPD (metarsal protrusion distance) indicates?

much longer 2nd met or short 1st. (-) indicates longer 2nd vs (+) indicates longer 1st.

Reiters - what is derm finding

mucocutaneous lesion and keratosis blennorrhagica

what is a flail chest? treatment of choice?

multi-rib fx, bruised lung can't exchange air. -Ventilator is tx of choice. pulmonary edema, tx with diuretics.

Ollier's disease

multiple endochondromas more common in children

Mosaic wart definition? what is a physcial exam finding consistent with a wart diagnosis

multiple plantar warts. side to side pinch pain (vs callus has pain with direct pressure)

Dermatomyositis

muscle weakness and skin rash

how can pts get a schedule II drug

must be prescribed by doctor, written

radiographic sings of a less agressive tumor (4)

narrow zone of transition geographic pattern no periostits sclerosing of normal bone

ultrasound near field vs far field

near field: stuctures in upper half of moniture vs far field: structures in lower half of montiure

US guided injection: how does the needle appear? how does the bolus of injection appear

needle: hyperchoic colus: hypochoic

iontophoresis, if you have *negatively* charged medication, which probe is used?

negative (cathode) The negatively charged chamber, called the cathode, will repel a negatively charged chemical into the skin.

Triple antibiotic Ointment ingrediatns (3)

neomycin sulfate, polymyxin B sulfate bacitracin zinc

Lambert-Eaton syndrome

neuromusuclar junction disease due to autoantibodis to presynaptic Ca channel--> decreaseing ACh release affecting m closer to the trunk (vs myasthenia gravis affects legs more than arms)

4 types of ulcer

neuropathic Ishcemic Decubitus Venous statis

plate designed to protect fracture sites from normal bending and rotational and axial loading plate

neutralization plate

good plate for a butterfly fracture

neutrilization plate

snow cap sign AVN

new bone over old.

is residence required to get licenced in a state

no

Does Seborrheic dermatitis cause hairloss

no they are flaky, white scales over erythematous patches, ages 20-50, in kids its called cradle cap

can you be liable at a scene of an accident?

no as long as there was no payment involved.

classical symtoms of DVT(3) and D-dimer value DVT gold standard dx?

no trauma, new onset of pain, swelling and redness in the leg with a D dimer >500 US

why wound Abx not be beneficial to PVD pt with dead bone

no vasclar to bring Abx to site

do orthotics help structual hallux limitus

no, b/c the hallux i limited when the foot is both loaded and unloaded.

which melanoma most often ulcerates and is worst prognosis and is second most common? It is often confused with a pyogenic granuloma? how to differentiate it as a vascular issue versus a melanooma?

nodular melanoma 15%. pressure for 30 seconds will collaps the vascular. W256

what is considered decongestive physiotherapy? (5)

non invasive: skin care manual lympahtic massage Exercise, PT compression bandage

Benign, metaphysis of long tubular Asymptomatic Expansive, elongated, radiolucent, multloculated lesions with cortical thinning

non ossifying fibroma

uses for an electrical bone stimulator (7)

non union, delayed union, charco, AVN, infection OM, arthropathy, acute fractures, bone graft.

Non-Stocahsic vs stochasitc sun burn will increase linearly the longer in the sun!

non-stocastic: more certain threshold linear

taper point needle used for (3)

noncutting, subcutaneus tissue, fascia

Gold standard diagnosis for CPRS

none its an exclusion diagnosis

Plantar fasciitis ultrasound normal pathological color

normal thickness is 4mm >4mm thickness, decreased echogenicity (darker)

Gissane angle

normal: *95-105* or 125-140 calcaneal fracture: increased. angle looks like a V "G for Great (increased)" *W474*

EMG

normal:unit potentials are properotioanl to effort abnorma: decreased motor units

Nodular fasciitis

notice thick collagen bundles; reactive pseudosarcoma; caused by trauma in 10-15% of cases CC: "nodules in forearm" sometimes "nodules in chest and back" "solitary, rapidly growing, sometimes painful mass" presence of extravasated red cells on biopsy associated with 17;22 translocation

open kinetic chain for MTJ

oblique axis is pronated longitudinal axis is supinated

where is the Antiglide Plate most commonly used?

oblique fracture of fibula W362

Man with episodes of blindness

occipital tumor

describe Evans calcaneal osteotomy procedure? indication?

open osteotomy of the calc 1.5cm proximal to the CCJ with insertion of bone graft -flexable pes planus W428

MTJ is in open or closed position during contact phase of gait? at contact what is the position and motion of the oblique and longitudinal axis?

open: *oblique axis:* pronated and does pronation (CC) *longitudinal axis:* is supinated and does supination. (TN)

sinus tract

opening to the outside

Gold standard for post op pain releif

opioids

case use

opposite side of injury

cutaneous larva migrans treatment (2)

oral albendazole or ivermectin

when to use oral vs topical steroids for contact dermatitis

oral with >20% skin surface affected (arms and legs)

what degree of care is required by a pod

ordinary standard of care

origin and insertion for EDB (3)

origin: sinus tarsi, Interosseous talocalcaneal lig, Inferior extensor retinaculum insertion: lateral side of EDL tenonds of digits 2,3,4 at level of base of proximal phalange and crontribute to the extensor hood.

The ossicle that may be responsible for a congenital talonavicular coalition would be

os tibialis externum

how does the role of a GRAFT affecte each of the 3: osteogenessis vs osteoinduction vs osteoconduction vs Creep substitution

osteo*g*enesis: new bone growth from cells in a *g*raft via cutting cone vs osteoi*n*duction: bone graft induces *n*onosseus tissue to become osteogenic in a favorable environment vs osteo*c*onduction: graft acts as latice and s*c*affold to allow surviving host to growth of surviving bone. hydroxyapatite vs *C*reeping Substitution: *c*utting cone of new osteo*c*lasts followed by osteoblasts which invade the grat application

Disorder of bone fragility chiefly caused by mutations in the COL1A1, and COL1A2 genes that encode type 1 procollagen. History includes Fractures after minor trauma, easy bruising, repeated fractures Hearing loss can occur in 50% with type 1, blue sclera with type 2

osteogenesis imperfecta

bone tumor to allivate pain with ASA

osteoid osteoma

pathology: Pseudofractures Looser Lines Milkmans syndrome

osteomalacia

Difference between osteoporosis and osteomalacia

osteoporosis: low amount of produced bone resorption > production (remodeling process is low) (low calcium) osteomalacia: architecturally normal with non mineralized osteoid bone (severe decreased vit D)

8 YOM fracture of tibia, most common tumor with elevated ALK? what radiographic signs give it away?

osteosarcoma (osteogentic sarcoma) -commonly found in distal femur, proximal tibia -watch out for the codman triangle (arrow), sunburst, onion skin -poor prognosis

Subungal exostosis xray

out growth that is same consistancy of bone (not radio-opaque or lucent)

ganglion cyst

outpouching herniation of joint or synovial sheath

Contraindication to diathermy (4)

over metal imlants pregnancy malignancy sensory loss

partial threaded screw omits what step in fixiation

overdrill

what steps in fixation should be the same size as the screw (2)

overdrill tap

surgery indicated for overlapping vs underlapping of 5th toe

overlapping: lapidus underlapping: thompson

Overproducer vs underexcreter or uric acid levels for gout Definition of each? which is most common? which occurs in lesch-Nyhan syndrome

overproducer: >600-800 uric acid excreted from kidney (lesch-Nyhan syndrome-treat with allopurinol) underexcreter is : <600-800 uric acid excreted from kidney more common treat with probenecid W178

what affects the ONSET of local anesthetic drug

pKa Inverse relationship smaller pKa=quicker onset smaller pka=smaller pH=quicker onset ie lidocaine, prilocaine, procaine (pKa 7.7-7.8)

common CI with therapy useing waves

pacemaker

cobra pad

pad for met head in dress shoes

Indication if a pin in an external fixator is loose or infected

pain

calcodynia

pain in heel due to fat pad atrophy

post static dyskinesia

pain with first step after rest

Myrmecia def? initial treatment of choice?

painful plantar warts. salicyclic acid

Virchow's node

palpable left supraclavicular lymph node associated with gastrointesintal neoplasm like pancreatic or gastric carcinoma

acute rheumatoid arthrits associated with

pancardidits and valvulits

loss of the anterior tibial and long extensors, and weakness of the posterior tibial, peroneal, and triceps. A flaccid pes valgus dropfoot gait is noted. What is the most appropriate method of treatment?

pantalar

primary lesion name for a acne, insect bites,warts, nevi, small melanomaflap

papule (fluid filled <1cm)

increase in eosinophil only

paracitic reaction

Incision should be made as _______ to these line as possible to minimize tension and dehiscence

parallel

shear

parallel deformation of internal surfaces of metal

normal vs coalition for middle and posterior STJ facets seen with the harris and beath

parallel-normal middle obliquly-middle facet coalition

As the STJ pronates, the two axis of the mid tarsal joint become _________=________which allows ________movement

parallel=unlocked increased

Fretting corrosion

passive layer of low oxygen is lost due to mechanical forces

what test to order with a nickle allergy

patch test

diaz-tachdijan classification

pediatric ankle fracture classification

desquamate

peel off in the form of scales.

difference between percoet and vicodin

percocet: oxycodone/acetaminophin "OP" Vicodin: hydrocodone/acetaminophin

describe gout on a xray: at least 5?

periarticular swelling joint margins errosions of joint punched out lesions complete lysis of bone Tophi (rat bite) overhaning erosions peri-articularly (martels sign) Joint space preserved

Ecchondroma aka

periosteal chondroma

creep definition in reguards to metal

permanent deformation of metal

-informed consent definition - child consent not required when -when do you have to listen to pt even if its harmful to them.

permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. child/minor (<18 years old) consent not required when life threating, may ignor partent refusal of care or religious views such as J dubs. Parents cannot withold life saving medicine from a child/minor (<18 years old). If its not a life or death emergency but serous, consult CPS for the consent. competant adult must be listened to unless pt is depressed or physc.

Rear foot varus causes increased strain on the _________tendon(s) which over time can cause a rigid deformity.

peroneal tendons

Peroneal subluxation on MRI -most common sport that cuases injury to peroneal subluxion

peroneus longus skiing

drug to reverse effects of anticholinergic in the OR

physiostigmine

calculate false positive? draw false postive positive chart? -label type I and II error - label sensitivity and specificy -label PPV and PNV -Which type error is considered underpowered in reserach

pic: a b c d false positive rate= FP / (FP + TN) false negative rate=FN / (FN + TP) Type I error=B (false positive) type II error= C (false negative) (underpowered) Sensitivity= A and C Specificy= B and D PPV= A and B PNV= C and D

coverleaf plate commonly used in

pilon fractures

External fixation pins: strenght, configuration vs wires: tensioning is different with foot vs ankle

pins: greater diameter, strongest figuaration is divergent wires: thinner but 1.5-2x stronger due to tensioning -60 (1000N) on foot -130 (1400N) on ankle

Psoriasis affects the nails how (2)

pitting salmon patches

Pharmacology: pka protein binding lipid solubility

pka: onset (inverse) protein binding: duration (direct) lipid solubility: potency (direct) "P does not go with P"

Denver Bar

placed under metatarsal bones to support transverse arch extending from the met heads to the tarsometarsal joint

In a Steindler stripping, which are stripped from periosteium of calc (5)

plantar fascia, plantar lig abductor H FDB ABDq (1st layer of plantar m)

on whom is the burden of proof in a civil malpractice

plantiff

what is burden of proof in malpractice case

plantiff must proove his case by preponderance of the evidence

what is doctrine of res ipsa loquitur

plantiffs technique to show breach of standard of care w/o direct evidence. for example forcepts found in pts abdomen

indication for talectomy

plantigrade foot

Kaposi sarcoma symtoms

plaque like

example of a load sparing implant

plate (reduces bone callous)

What is the orthoposer?

platform that enables WB images of foot and ankle to be obtained, Xray film or image receptors on the orthoposter can lei flat or be placed vertically

osteochondroma direction to joint? how common it it?

points away most common benign bone tumor!!!

Hypothyroidism symptoms? does it cause muslce weakness?

poor ability to tolerate cold, a feeling of tiredness, constipation, depression, and weight gain muscle weekness in children

circlage indication

poor bony stalk

medial inferior genicular artery supplies blood to (1)

popliteus

Trendelenburg position? Trendelenburg maneuver?

position is head lower than feet. maneuver differentiate deep and superficial venous congestion. Elevate leg to empty venous blood Place tourniquet around upper thigh ~30-60mmHg to occlude superficial flow Have patient stand

hampton's humb sign

positive for PE

Schober test

positive test for ankylosing spondylitis: negative test (normal person): a 10 cm lenghth is measured on erect spint, pt bends forward and the measurment should increase by 4cm.

in what foot type is Meary's angle positive? negative?

positive: supinated foot negative: pronated foot

pseudogout arthrocentesis lab work

positively biefringment rhomboid-shaped crystals

what does PACU stand for

post anesthesia care unit

POUR stands for

post op urinary retention

what does PONV stand for

post operative nausea and vomiting

axial sesamoid view

posterior 90,heel on platform

Isherwood lateral oblique axial position

posterior facet of STJ

direction of an achilles tear

posterior fibers are torn first so direction is: *posterior to anterior*

attachement for Inferior Tranverse lig

posterior tibia---Superior portion of malleolar fossa

What is the muscle that is most commonly transferred through the interosseous membrane to function as a dorsiflexor of the foot?

posterior tibial

Volkmann Fracture

posterior tibial malleolar fracture, seen in SER III and PER IV.

DVT leads to veins that are incompetint this is called vensou insuffisciency AKA

postphlebitic syndrome W78

what form does the antibiotic need to be in for antibiotic beads

powder

which virus is the larges virus

poxviridae W64

Basal vs prandial insulin

prandial (rapid-acting or "mealtime" insulin) -"Girls and Lads" Glusine, Aspart, Lispro Intermidiate: -"Rest Now" Regular insluin, NPH *basal (long-acting insulin)* -"Dont Go" Detemir, Glargine

lab for immediate nutrition status

pre-albumin (15-30 mg/dl) ( < = poor nutrition status)

lawn-ganong-Levine syndrome

pre-excitation syndrome of the heart due to abnormal electrical communication between the atria and the ventricles

law: define discovery

pre-trial process to obtain facts from other side including -relevant facts -documentation -evidence -preserve testimony -narrow issues -remove surprises -interogations

classification of polydactly? most/least common type?

preaxial: hallux central: digits 2-4 (least common) *postaxial: 5th digit (most common)* W440

patent had pain over 2nd MTP,swelling, some dorsal dislocation. What is thediagnosis?

predislocation syndrome

action of Tibalis Posterior at heel strike

prents STJ pronation

function of methlyparaben to anesthetics

preservative to local anesthetics to increase shelf life

function of Whitman-Roberts

prevent adduction and plantarflexion of the talus (high medial flange with a lateral clip and a cupped seat)

indication for deep heel cup

prevent overpronation

purpose for FF orthotic extension?

prevent slippage shock absorb

Marjolin ulcer develops from (3)

previous trauma chronic inflammation scarred skin

level of disease prevention: A doctor tells pt to wear a seatbelt

primary (trying to prevent yourself from getting a disease)

cause for underexcreter of uric acid gout; Primary cause? Secondary cause?

primary: kidney issue secondary: excessive acids such as lactic acid or ASA. Lead poisoning W178

p-value (significance probability) small vs large p value type 1 vs 2 error

probility that results could result in same outcome <0.05 reject null hyphothysis. >0.05= cant reject null hypothysis type 1: rejecting a true null hypothesis. type 2: fail to reject a false null hypothesis

define creeping substitution

process of cutting cone of new osteoclasts, followed by osteoblasts will invade the graft from the host bone

The direction that an xray beam travels through the body is:

projection

least reactive suture, plate

prolene (suture) stainless steel (bone fixation)

hypocalcemia EKG

prolonged QT interval

position Mid tarsal joint needs to be in when being fitted for orthotics due to plantar fascitis

pronated

The midtarsal oblique axis pronates, and the midtarsal joint longitudinal axis supinates. Is the midtarsal joint in pronation or supination?

pronates

what is a MAD axis

pronitory/supinatroy joint that moves in the direction of MAD (medial anterior dorsal)

any surgery lasting more than 120 minutes requires the use of?

prophylactic antibiotics

What is the main drug used in the OR that you avoid in pt's with an egg allergy?

propofol

onchronitic shards association

prosthetics

prealbumin is a good measure of

protein

what affects the DURATION of a local anesthestic drug

protein binding direct relationship -larger protein binding %=longer duration (bupivacine has 90%) -smaller protine binding %= shorter duration (lidocaine has 64%)

increasing pitch on a screw does what

provides larger area of contact between cancellous screw and bone (cancellous screws have a larger pitch)

course of deep peroneal nerve in proxima middle and distal tibia

proximal: between TA and EDL, middle: between TA and EHL, distal: medial to TA and lat to EDL

most common 5th met fracture

pseudo-jones fracture Type 3 Stewart

Calcium pyrophosphate dihydrate crystals build up in a joint differential

pseudogout

aspiration of rhomboid crystals

pseudogout

donovex is a treatment primarily for what

psoriasis (its a Vit D analog)

how can a pod protecti himself from a charge of battery

pt informed consent

Papineau sign

punctate bleeding seen in cortical bone indicates health bone. need to see when debriding dead bone segments so you know the resection is proximal enough and youve reached viable cortical bone

cloaca

pus filled space where sequestrum resides

how often are inpatients vitals checked

q8 hours (shift change)

is the lace stay on a shoe on the vamp or quarter

quarter

Stochasitc

random more exposure=liklyhood of occurance no threshold, non linear random mutation, CA

PCN allergy signs

rash hives (urticaria) swollen tongue wheezing cardiovascular collapse Laryngospasm

keratoderma blennorrhagica association

reactive arthritis

the coleman block test determines whether a _____________ deformity is flexible or rigid

rearfoot varus

Indiciation for tension band wiring. example?

reattachement of small fragments, too small for a screw. avulsion fracure of lateral mal

Somogyi effect

rebound hyperglycemia in AM due to glucagon/epi secretion responding to overaggressive insulin therapy the night before.

bias types (4)

recall, performance, selection, lead time

post procedure indication

rectus hammertoe (resection of head of proximal phalanx)

alpha glucosidase inhibitors moa? 2 drugs?

reduce intestinal carbohydrate absorption -acarbose -miglitol P72

on the postive: adding arch fill vs minimal arch fill

reduces arch vs creats conforming total contact othotic becuase more pressure is on the arch.

Intrinsic hemolytic anemia def

refers to a defect in the RBC causing the anemia (membrane defects, abnormal Hb, enzyme deficiency)

Westmark sign

regional area of decreased pulmonary vascularilty on CXR PE

p-value of <0.05 means?

reject null hyphothysis type 1: rejecting a true null type 2: fail to reject a false null

What is equation for radiation for workers

related to amount of mrem/year

type II lawson

remaining attached larger navicular ossicle next to navicular tuberosity

Auspitz sign

removal of silverly scales in *psoriasis* results in pinpoint bleeding

Lambrinudi arthrodesis

removes bone from distal plantar talus and displaces navicular dorsally, it correct foot equinus but leaves talus in perferred equinus position.

if adding a kirby(medial) skive onto the postive what is done? purpose?

removing small amounts of medial heel creates the varus wedging affect. to control pronation, need a deep heel cup. can skive 2,4,6 mm of positive.

Creatinine (cr) levels indicate

renal health

why cant toradol (ketorolac) be used for more than 5 days

renal toxicity

Cheyne-Stokes respiration

repeated breathing pattern characterized by fluctuation in the depth of respiration: first deeply, then shallow, then not at all until apnea occurs

fatigue fracture in metal

repetative applications of loads below yield strenght

yount (keyhole) flatfoot correction

reroute anteior tibial tendon through keyhole in navicular without detatch insertion, with poserior tibial tendon advancement under navicular

pH <7.35, PCo2>40

respiratory acidosis

under what law is a doctor responsible for his nurses negligence

respondeat superior

drug to give with infected hardware? when to leave in hardware when infected bone?

rifampin. keep in hardware if instability of bone is a risk becuase unstable bone is more prone to infection

what is used most often to irrigate in ankle arthroscopy

ringers because its less damaging to chondrocyte metabolism

Angles/position for ankle fusion: sagittal plane? valgus? externally rotated?

sagittal plane neutral *90 degrees* valgus *0-5 degrees* externally rotated *5-10 degrees*

Pagets disese radiograph stage 3

sclerotic stage, osteoblastic, thickened trabeculae, ivory appearance of bone, bone expansion

PONV drugs (5)

scopalamine Promethazine Ondansetron Corticosteroids metoclopramide

type and screen vs type and cross

screen: screen donor and recipient blood for *antibody* vs cross: mix recipient's and donor blood sample to check for *reaction*

Which of the following is commonly associated with osteoporosis

scruvy

degree of frostbite: -superficial dermis -creating blisters that will drain and form eschar

second degree

stage of CPRS: activity related pain and hypersensitivity of skin to temp and pressure. radiographs show sudeck atrophy changes for 3-6 months

second stage: dystrophic

level of disease prevention: trying to detect a disease early and prevent it from getting worse.

secondary

Berndt-Hardy classification: how to treat Berndt-Hardy lesions

see pic I,II NWB cast III,IV excision, ORIF

Hoffa sign:

seen in calc fracture where the tuber fragment displaces superiroly, relaxing the tricepts and decreasign its platarflexory power. shortening the calc lever arm.

Gower sign

seen in muscular dystropy, kids raise themselves up by first crawling

hutchinson sign melanoma

seen in subungal melanoma

semitubular plate, one third tubular plate, and one quarter tubular plate are all examples of what type of plate

self compressing plate (eccentrically sloped oval holes for screws)

are bone scans better for sensitivity or specificty

sensitivity

Specificity vs. Sensitivity

sensitivity - The probability that a test will indicate a disease among those with the disease *true positive* specificity - is the fraction of those without disease who will have a negative result: *true negative*

50,000-200,000 WBC with >90% nuetrophils vs <100,000 WBC with 50-90% neutrophils, cultures negative

septic arthritis vs inflammatory arthritis

gold standard for MA treatment in kids begin at 8 mo old

serial casting is gold standard

best view for: crista

sesamoid axial.

insertion for Flexor digitorum brevis

shaft of middle phalanx

phosphate injectable: length acting? soluable? location? color? ie?

short acting H2O soluable Injectible anywhere Clear Celestone phosphate, celestone soluspan (both), Dexamethasone (both) vs Acetate: Triamcinolon (kenalog, celeston soluspan, Dexamethasone

A 20-year-old male sustains his first ankle injury which is diagnosed as a rupture of the lateral collateral ligaments of the ankle. What is the most appropriate treatment plan?

short-leg nonweightbearing cast for eight-to-ten weeks

Wolf-parkinson-white-syndrome

shortened PR, aka bundle of kent. (Symptoms can include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope) W152

benefits of adding epinephrine to local block (3)

shortens onset of anesthesia increases duration of block vasoconstrictor

-Long bone pain, foot and hand pain, -Arthritis with a fever -AVN femoral head -chronic punched out lesions ankles -Abdominal pain with vomiting Diagnostic test to confirm? Best treatment

sickle cell anemia Hemoglobulin electrophoresis shows hemoglobin S, periperhal smear shows sickling Folic Acid

topical medications for burns (3)

silver nitrate, silver sulfadiazine, sodium mafenide W491

Homocysinuria

similar to marfan syndrome but the pts are retarted and have large amouts of homocystine in urine

define Arthroresis

sinus tarsi plug

SE of niacin (3)

skin flushing, pruritis, Rhabdomyolysis

Osteoma most common location? multiple osteomas are commonly seen in what pathology

skull Gardner syndrome (supernumerary teeth, fibrous dysplasia)

A 12-year-old male Judo patient who is overweight, limps into the office with pain in the upper thigh. The radiograph demonstrates posterior displacement of the growth plate. The appropriate diagnosis is

slipped capital femoral epiphysis.

oat cell carcinoma

small cell carcinoma: highly malignant form of lung or bronchogenic cancer in which cells appear small and rounded under a microscope

type 1 lawson

small round accessory navicular ossicle within TP tendon

small fragment screw set (2)

small: 3.5. 4.0 W359

CMT degeneration pattern? how proximal are m spared?

smaller mucles ----> larger muslce groups mucles above the knee are generaly not invloved

In a pediatric patient with a physis fracture what should you use for fixation

smooth pins

Difference between spinal and epidrual anestheisa

spinal anesthesia: *one time* injection of anesthesia. pierces the dura epidural anestheisa: *catheter placed* for ongoing anesthesia, anestheic placed into epidural space

dermatome harvesting is most commonly used with split vs full thickness grafts

split

Christman-Snook: indication?

split PB, through fib ant-post, down into calc indication: ATFL + CFL lig repair:

calcanealnavicular lig aka

spring

bowen's disease

squamous cell carcinoma in situ that resembles a localized patch of psoriasis, dermatitis or tinea (in situ means its still confined to the epidermis, considered as an early stage or intraepidermal form of squamous cell carcinoma.

action fo TP,Peroneals, intrinsic m at midstane

stability

what are oilive wires when used in Ex fix

stabilize and prevent wires from sliding back and fourth

twighlight stage of anesthesia

stage 3

National Pressure Ulcer Advisory Panel

stage I: not broken stage II: Epidermal breakdown (shollow) stage III: Dermis/sub c breakdown stage IV: mucle/bone + necrotic, + drainage unstageable: Eschar/slough entire wound W264

Guedel's stages of anesthesia: analgesia, disorentation

stages of anesthesia: *stage 1: analgesia, disorentation* stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death

Guedel's stages of anesthesia: delerium, excitment

stages of anesthesia: stage 1: analgesia, disorentation *stage 2: delerium, excitment* stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death

Guedel's stages of anesthesia: reflexes lost: eye, swallow, conjunctival

stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia *1 plane-reflexes lost: eye, swallow, conjunctival* 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death

Guedel's stages of anesthesia: loss of light relfex, dialted pupils

stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 *plane -loss of light relfex, dialted pupils* 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death

Guedel's stages of anesthesia: complete intercostal paralysis to diaphragmatic paralysis (apnea

stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-*complete intercostal paralysis to diaphragmatic paralysis (apnea)* stage 4: respiratory stoppage to death

Guedel's stages of anesthesia: relfexes lost: laryngeal, corneal, tears (most nobily known for change in breathing pattern)

stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2* plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern)* 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death

which guedel stage is Surgical anesthesia?

stages of anesthesia: stage 1: analgesia, disorentation, amnesia stage 2: delerium, excitment *stage 3: surgical anesthesia* 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern), loss of eyelid reflex 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death. overdose

how dose Periodic Acid-Schiff stain test diagnose fungus?

stains polysaccharides in cell wall-stains magenta

how does stance phase in gait change with walking vs running

stance phase with walking=60% (swing phase is 40%) stange phase with running=40% (swing phase is 60%)

clindamycin is best used for (6)

staph strep celluitis gas (closteridium perfringens) abcesses moderate to severe acne

micro that causes Furuncle Carbuncle Folliculitis

staph a (according to prometric). pseudomonas (according to watkins) Sooooo Freakin dumb

What causes cellulitis? 2 most common

staph a and Strep (most common) E-coli Klebsiella Staph epi

Ketamine uses (5)

starting and maintaining anesthesia. induces a trance-like state pain relief, chronic pain sedation, sedation in intesnive care memory loss.

diagnosis: -located just proximal to medial malleolus, erythematous scaling plaques with exudation, crusts, superficial ulcers. -pt will complain of mild pruritis, pain, edema, nocturnal cramps, and painful ulcers, may be associated with reticulated hemosiderin hyperpigmentation

stasis dermatitis W 239

a liscence to practice podiatric medicine is issued by?

state medical board

law of reciprocity

states that the 2 factors for xray denisity are Exposure time and milliamperes (mAs)

tetraology or Fallot

stenosis Intraventricular septal defect right ventricular hypertrophy cyanosis

Damage to deep peroneal nerve, what kind of gait?

steppage

steps of calc fracture repair

steps Insert Schantz pin for reduction, restore height, return heel to valgus, medial translation.

How to treat pyoderma gangrenosum?

steroids (this is seen with IBS)

which stewart classification is the jones fracture

stewart 1

Define modulus of elasticity

stiffness of an alloy (calcualted by dividing stress load by strain or defomration)

ephedrine use

stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anesthesia.

Oblique resection of 1st met head with normal WB portion of sesamoids left intact

stone

Stable angina with normal EKG, what is best test to check heart next?

stress EKG

diagnostic imagin to confirm ankle sprain

stress radiograph

What is best option to treat hematoma?

stretching

an equino varus deformity after a TMA will result in transfer ulceration where

sub 5th met base

Geodes aka

subchondral cysts have arthrtic changes and are found in joints.

difference between: subcutaneous calcaneal burisits vs subtendinous calcaneal bursitis

subcutaneous calcaneal burisits: between achilles tendon and skin vs subtendinous calcaneal bursitis: between achilles and calc

reiters disease tx

sulfasalazine

which melanoma occurs most often

superficial spreading melanoma 70% W256

what makes up the boundries of the popliteal fossa

superior medial: semi membranous/tendonosis superior lateral: biceps femoris infeior meidal: medial head of gastroc inferior lateral: lateral head of gastroc

Inferior muscular a aka

sural

what are the types of debridement (4)

surgical enzymatic mechanical autolytic

when do you order blood cutures for a DM ulcer

suspection of sepsis -require 3 samples each from different locations or same location 10 min apart -best when pt is feverish

Rowe 1B:

sustentaclum tali

what is the swag on a suture?

swag: where needle meets suture

Following removal of the proximal phalanx of the fifth digit, what is an appropriate surgical procedure for prevention of fifth digit flailing?

syndactilization

Most common malignancy in foot

synovial sarcoma

what does talipes refer to

talus and pes

best needle shape for subcutaneus tissue fascia: -referse cutting? -taper cutting? -taper point? -blunt point?

taper point

taper cutting needle used for (4)

tendon, ligament, blood vessels, periosteum

Interference screws aka

tendonesis screws

roof type for fracture blister: serous filled blister vs hemoragic blister Deroof?

tense vs flaccid Dont deroof a fracture blister

plate associated osteoporosis

term for plates with screw fixation that leads to impaired periosteal blood flow

purpose of a Grid in radiographs

the alternating strips of lead and aluminum absorbs the scatter

what makes up the lisfranc joint

the five tarsometatarsal joints involving three longitudinal columns 1.medial: first ray 2. middle: 2nd and 3rd tarsometatarsal joints 3. lateral: 4th and 5th tarsometatarsal joints

Levine's sign

the global position of heart attack; a fist clenched over the chest

"due proccess law" prevents the revocation of a pods liscens without?

the law requires a "hearing after notice"

how should a DMII handle thier long acting insulin leading up to surgery in a well controled DMII

the night before 2/3 pt's usual dose the morning of 1/2 pts usual dose mcglamery 58

piriformis sydrome

the piriformis muscle compresses the sciatic nerve.

what is an arthrocentsis

the process of gathering synovial fluid from a joint

Who decides standard of care?

the profession

define attenuation in reguards to a radigraph

the thicker a substance is the more it absorbs xrays

neuroma in relation to DTML

thickening of epineurium from entrapment *plantar to* DTML W12

what is a rim sign

thin layer of active infection surrounding normal bone, seen in OM on a T2 MRI

chemical matrixectomy is what type of burn

third degree

stage of CPRS: skin and muscle atrophy for more than 6 months

third stage: atrophic

major side effect to Heparin

thrombocytopenia (low levels of thrombocytes)

Stellwag's sign

thyrotoxicosis infrequent and/or incomplete blinking, accompanied by Dalrymple's sign

what is a blair fusion

tibial calcaneal fusion after a talectomy

ankle block (6)

tibial n saphenous n Medial Dorsal cutaneus n Deep peroneal n Intermedial Dorsal cutaneus n Sural

sesamoid position 3=

tibial sesamoid is paritaly bisected lateraly

Treatment for Dermatitis/Ecema

topical corticosteroids

Person with lichenus lesions around ankles at border of shoes with itching, what do you do?

topical steroid

under what catergory is a medical mal practice case (based on neglagence)

tort

what is Kite's error

touching or manipulating the calcaneus during the ponsetti technique

Difference between traditional vs Fallat and Bukholz

traditional: bisection of 4th and 5th Fallot and Buckholz: bisection of 4th and medial margin of proximal 5th

the most common SE for epinephrine is

transient tachycardia after inadvertent intravascular injection

What 2 planes do you image in ultrasound?

transverse (A) produces a coronal Longitudinal (B) produces a sagittal section

what makes up the Cruciate Anastamosis

transverse br of MFC transverse br of LFC Inferior Gluteus 1st Perforating

Cincinnati Incision

transverse incision that involves extensive dissection of the posterior, medial and lateral ankle

Kite is 50 and cc is 25 on ap, lateral calc inclin is 20? What is the plane of deformity?

transverse. kites normal: <25 calc inclin normal: 25 cc angle normal: 0-5

outlast shoe

transvese plane correction for metatarsus adductus (shoe that is diected outward)

Positive PPD and negative CXR what do you do?

treat with isoniazide

name the acetate injectibles

triamcinolone (kenalog)

Ankle fx looks like SH2 on one view and SH3 on another view,=

triplane fracture

A 30-year-old male, who had a resection of a calcaneonavicular bar at age 11, exhibits fixed valgus deformity of his foot. Radiographs demonstrate the recurrence of a calcaneonavicular coalition with subtalar joint degeneration and talar beaking. What is the appropriate surgical treatment?

triple arthrodesis

T:F Pt with CHF don't use calcium-channel blocker

true

T:F you can use ex fix on comminuted fractures

true

T:F you can use ex fix on open fractures

true

Salter Harris: Transverse minor fracture through growth plate without shortening

type 1

type of collagen in maturation phase of healing creating scar

type 1

type 1 vs 2 osteoporosis

type 1: post menopausal (increased osteoclasts), decreased PTH type 2: age (decreased osteoblasts), increased PTH

type 1 error vs type 2

type 1: rejecting a true null hypothesis. type 2: fail to reject a false null hypothesis

Salter Harris: Through growth plate and traveling above into the metaphysis. Its Extra-articular with minamal shortening. no functional limitations after healing

type 2

Salter-Harris Fracture: Through the growth plate and traveling below into the epiphysis. Intra-articular and can cause shortening

type 3

Pt presents with bifid (cleft) epiphysis, which salter harris classification must you rule out:

type 3 a cleft is a normal varient withing growth plates that can resemble a fracture. xrays will help rule out fracture as fracture shoes sigsn of healing in 2-3 weeks

Partial Incongrutiy of mets 2-4 (lateral displacement)

type B2 Hardcastle

most common salter harris fractures

type II thurstan holland sign

thread hole, pilot aka vs glide hole

underdrill vs overdrill

thompson procedure indication

underlapping 5th toe

midtarsal joint at contact?

unstable

orthotripsy ie

using soundwaves to treat Plantar fascitis reduces inflammation ie OssaTron

A patient presents with a brachymetatarsia on the fourth metatarsal right foot. What is the limiting factor when considering the maximum length that may be added to the metatarsal?

vascular length

Major SE for Propofol (1)

vasodilatin SP204

medial superior genicular artery supplies blood to (2)

vastus medialis articularis genu

telangiectasis is an early sign of_______disease (arterial or vein)? diameter size? aka?

vein. <1mm in diameter. aka spider veins

function of a flange on orthotic

vertical exetension of basic orthotic to *more control* supination or pronation

Nitroous oxide has a high or low MAC?

very high (>100%)= not very potent W56

if a pt is in shock and loosing blood, why cant you just give him a vassopressor

vessels are max contronstricted

vertical mattress stich vs retention stich

vetical: far-far, near-near retention: far-near, near-far

increase in lymphcyte only

viral infection

which vit B can help with neuropathy

vit B12

Homeless man with MCV 110 (macrocytic), what is cause of anemia?

vit B12 def

Pathology? -Crowe sign -Lich nodules

von Recklinghausen disease -Freckling of the axilla - hamartomas in the iris but doesnt affect vision

wart vs callus skin lines go around lesion

wart

wart vs callus: pain with lateral pressure

wart

when is okay to do arthrodesis of the AJ in equinus?

weak quads

wet vs dry gangrene

wet: infected dry: non-infected

What does Mattles test and Simmonds test?

when a person is prone with knee at 90 and when a pt is prone the postion of the foot in a normal non achilles torn tendon is *plantarflexed*

coleman block test determines what

whether a *REARFOOT varus deformity is flexible or rigid.* Pt is placed on wooden block 1 in thick so that the enitre foot is standing on the block exept the medial forefoot. -In a *flexible rearfoot varus:* the 1st metatarsal will plantarflex down to the ground and the rearfoot varus will evert into a corrected position telling us that the varus deformity is caused by a plantarflexed first ray (this needs to corrected by doing a dorsalflexory wedge osteotoomy of first metatarsal) -In a *rigid rearfoot varus*: the foot will not correct indicating that an isolated forefoot sx will not correct the varus deformity and would need a rearfoot surgical correction such as Dwyer (lateral closing wedge

Muehrcke's lines nail

white transverse bands occurring in pairs- hypoalbuminemia

white toe vs blue toe

white: arterial problem blue: venous problem

issue with over countersinking? what can be placed if done

with a weakened cortical bone, the screw may sink into cancellous bone a washer

occurence malpractice policy vs claims made malpractice policy

with occurence, the doctor is covered even after the occurence malpractice policy expires vs claims made malpractice, the doc is not covered when the policy expires.

what is libel

written defamation

Form of ionizing radiation

x-rays, gamma rays, neutrons

how to change mAs with wet plaster

x3

blood culture taken

x3, x 3 different places, 30 min apart

Light source for ankle scope from most powerful to least powerful: (3)

xenon most powerful, metal halide, tungsten least powerful

Can punitive damages be awarded in a successful suit for slander?

yes

difference between ausitin and youngswick bunionectomy

youngswick has an additional cut to take out a piece of bone thereby correcing metatarsus elevatus

gastrosoleus zones

zone 1: gastroc origin zone 2: distal gastroc to disal soleus before achilles zone 3: achilles