Externships and Interviews

what are the anaerobic gram positive rods?

C. perfringens - racquet shaped C. difficile C. tetani

Which ankle ligaments are extra-capsular? Which are intra capsular?

Calcaneofibular ligament is extra-capsular, all others are intra capsular

what are the subacute signs of OM? what are the chronic OM signs?

brodie's abscess - found in metaphysis of long bones. (radiolucent cavity/cyst surrounded by sclerosis) sequestrum - dead bone floating in pus. involucrum - sheath of bone/thickened periosteum surrounding pus cloaca - tract through an involucrum sinus tract - opening to the skin

the medial compartment communicates to the distal deep leg and vice versa via the?

flexor hallucis longus tendon

what would you see on technetium 99 bone scan if you suspect cellulitis? OM?

focal uptake in blood pool, negative in delayed phase diffuse uptake in blood pool, increased uptake in delayed phases.

pain in the RUQ indicates? pain on LUQ indicates? RLQ indicates? pain in the LLQ indicates?

gallstones, cholecystitis, biliary colic, hepatitis. splenic infarct, gastritis, constipation. appendicitis, ureteral colic, gyn, crohns diverticulitis, abdominal aortic aneurysm, gyn.

what does HMPAO stand for?

hexamethylpropyleneamine oxime

band cells are often seen in?

immature neutrophils often indicates active, ongoing infection.

thurston holland sign is seen with?

salter harris type II metaphyseal bone is fractured is what thurston holland sign indicates.

remember that the pulse oximeter reads the oxygen ___________, not the ____________.

saturation, not the p02 90 saturation corresponds with about 70 partial pressure (p02)

what is the pathogenesis of neuropathy in diabetics?

sorbitol accumulation in schwann cells leads to hyperosmolarity of the nerve cells in turn leading to swelling and cellular lysis. - this leads to decreased nerve signal conduction.

closure of the physis starts where?

starts central and goes medial closes laterally 18 months later complete closure by 15 years

an enlarged os trigonum is called? and if it fractures?

steida process shepherds fracture - acute fx of the posterolateral talar process.

what are the different types of coalitions?

syndesmosis - fibrous synchondrosis - cartilaginous synostosis - osseous

what do park harris lines indicate?

transverse lines in the bone that indicate growth arrest. parallel the physis - no growth disruption angled or point to physis - suspect disruption.

what does an S4 heart sound indicate? what does an S3 heart sound indicate?

left/right ventricular stiffness - increased resistance to filling of the left or right ventricle because of a reduction in ventricular wall compliance. - heard before S1 congestive heart failure - deceleration of blood flow into the left ventricle from the left atrium.

which neuro column is assoc. with vibratory, proprioception? which is assoc. with light touch? which is assoc. with pain and temp? which is tested with semmes 5.07 monofilament?

posterior anterior lateral anterior column

What is the strongest lateral ankle ligament?

posterior talofibular

what are the aerobic gram negative rods?

pseudomonas E. coli enterobacter proteus vibrio Y. pestis shigella salmonella klebsiella serratia e. corrodens Pasturella multocida

burning and tingling pain in one extremity only, can be due to?

CRPS

What is staking the head?

Excessive resection of the 1st metatarsal head medial eminence with cutting into the sagittal groove may lead to hallux varus - *most common cause*

What ligaments support the ankle syndesmosis?

Anterior-inferior tibiofibular ligament (bassett ligament) Posterior-inferior tibiofibular ligament Interosseous tibiofibular ligament

what causes blue nails?

Causes include antimalarial drugs, minocycline (a tetracycline), hemochromatosis (an iron metabolism disorder), Wilson dz, ochronosis (a metabolic disorder), and exposure to silver nitrate.

what procedure for the correction of cavus foot is a dorsiflexory wedge of the naviculocuneiform joint and cuboid?

Cole

What is mycosis fungoides?

Cutaneous T-cell lymphoma that can resemble eczematoid or psoriasis

What pathway do NSAIDs work on?

Cyclooxygenase (COX) NSAIDs nonselectively inhibit both COX-1 and COX-2 pathways

what is agenesis of the fibular sesamoid?

Ilfeld's disease

why is gas gangrene a medical emergency?

It rapidly progresses to shock and renal failure and is fatal in 30% of cases

When looking at a calcaneus fracture on CT, how do you decide you are at the right section to determine the right Sanders class?

The widest portion of the posterior facet.

Where does plantaris insert?

Medial aspect of tendo-Achilles into the calcaneus

What layers of the foot do the plantar nerves run?

Medial plantar nerve - in the 1st layer (between FDB and abductor hallucis) Lateral plantar nerve - between the 1st and 2nd

What nerves form the sural nerve?

Medial sural cutaneous nerve - branch of the tibial nerve Sural communicating branch - branch of the lateral sural cutaneous nerve, which originates from the common peroneal nerve

Flat, pink, red, or purple as a result of vascular ectasia, May indicate Sturge-Weber syndrome.

Nevus flammeus

What is the most common benign primary bone tumor?

Osteochondroma

what stain is used for diagnosing fungus? what does the stain adhere to?

PAS - periodic acid schiff stains the polysaccharides/carbs in the cell wall of fungal hyphae

what test has the highest sensitivity and specificity for OM?

PET scan - positron emission tomography

What is the difference between Percocet and Percodan?

Percocet has 325 mg of acetaminophen and Percodan has 325 mg of ASA

What should be done if the capital fragment falls on the floor?

Rinse with saline Bacitracin soak for 15 minutes Rinse with saline Bacitracin soak for 15 minutes Rinse with saline Document and inform patient

Who first described the triple arthrodesis?

Ryerson

Pain management with a codeine allergy?

S - Stadol/butorphanol T - Toradol/ketoralac U - Ultram/Tramadol D - Darvon/darvocet/propoxyphene D - Demerol/meperidine N - Nubain/nalbuphine

What is an anti-tension line?

S-shaped or zig-zagged incision when exposure needed is not parallel to RSTL

what heart sound is due to the closure of the AV valves? which is due to closure of the semilunar valves?

S1 S2

would you use the diaphragm or the bell for S1? for S2,S3,S4?

S1 and S2 - diaphragm S3 and S4 - bell

which heart sound is due to rapid ventricular filling?

S3

an S3 is often due to? an S4 is often due to?

S3 - normal in youth or CHF or mitral regurg S4 - normal in youth/athletes or HTN or aortic stenosis

which shoe modification can simulate plantarflexion at heel strike to decrease ground reactive forces?

SACH heel

What is the MOI causing a transverse lateral malleolar fracture?

SAD I

if you see a vertical medial malleolus fracture, what type of lauge hansen ankle fracture is it?

SAD stage II

a bosworth fracture is associated with which lauge hansen class?

SER

an excess in ADH is called? a deficiency in ADH is called?

SIADH - hypertension, and hyponatremia - tx with demeclocycline. Diabetes insipidus - hypernatremia, and polyuria get serum and urine osmolarity.

what will the EKG show on stable or unstable angina?

ST depression with flattening of the T waves cardiac enzymes are negative

what is the hallmark of myocardial injury?

ST segment elevation

which total ankle replacement hardware are three component?

STAR - scandinavian total ankle replacement Mobility total ankle system - poor performance Hintegra - Canada and Europe only Buechel Pappas Implant- not FDA approved

What tendons pass over the deltoid ligament?

Tibialis posterior and FDL

What are the sources of blood supply to the talus?

Superior surface of head and neck - artery of sinus tarsi and branch from anterior tibial artery or dorsalis pedis Medial side of body - artery of tarsal canal and posterior tibial artery Lateral turbercle - anastamosis of branch of peroneal artery with medial calcaneal branch

what are the sizes of the k wires? what are the color caps?

.028, .035, .052, .045, .062 all in inches. yellow, blue, white, green

what is the normal calcaneocuboid angle?

0-5 greater than 5 is pes planus or flat foot

what is a Normal compartment pressure? When do you start getting worried? When do you consider surgical intervention?

0-5mm Hg 20-30mm Hg >30-40mm Hg using a wick/stryker/slit catheter

a skin perfusion pressure of less than _____ have a low probability of healing.

30 mm Hg same with TCOM

What therapeutic effects are seen with acetaminophen? what is the maximum daily dose?

Analgesic and anti-pyretic 4 g

What therapeutic effects are seen with most NSAIDs?

Analgesic, anti-pyretic, and anti-inflammatory

what orthotic modification is used for a flexible flatfoot with tight/short achilles tendon?

a deep heel cup to control the to heel in a more vertical position, with a medial flare

what procedure performed for frontal plane flatfoot deformity is an osteotomy inferior tot he STJ posterior facet of the calcaneus with bone graft?

Baker

What bone tumors do not form matrix?

Bone cysts Ewings sarcoma Giant cell tumor

What are the most common cancers that metastasize to foot? which are the most common metastasis to the lower extremity bones?

Breast, prostate, lung, kidney, thyroid breast and prostate

what are the causes of ulceration?

abnormal anatomy decreased joint mobility equinus - incr. forefoot press skin stiffness intrinsic skin weakness

what is a partial joining of digits with a proximal opening?

acrosyndactyly due to environmental factors

what are the silver dressings?

acticoat, sulfadiazine cream, polymem, actisorb plus.

patient is a farmer/californian/anybody exposed to a to of sun with an area that appears erythematous with a sandpaper-like yellow to white scale.

actinic keratosis - can convert to squamous cell carcinoma primary treatment is cryosurgery, 5-FU is secondary if can't do surgery

what is an infection of the endothelial surface of the heart that results in vegetations of platelets, fibrin, and microorganisms on the heart valves?

acute endocarditis - more common in IV drug abusers subacute endocarditis - more common in native valve disease libman-sacks endocarditis - common in SLE pts due to antibody

what type of leukemia is CALLA antigen positive?

acute lymphocytic leukemia (ALL)

a peripheral smear shows blasts with auer rods and myeloperoxidase granules.

acute myelocytic leukemia AML

patient experiences pleuritic retrosternal chest pain that is worse when supine, and improved with sitting up. what will the EKG show?

acute pericarditis concave ST elevation across all leads, with PR depression early

what muscles are innervated by the deep branch of the lateral plantar nerve? what muscles are innervated by the superficial branch of the lateral plantar nerve?

adductor hallucis (both heads) 1st - 3rd dorsal interossei 1st -2nd plantar interossei flexor digiti minimi quinti 4th dorsal interossei 3rd plantar interossei

primary adrenal insufficiency results in loss of which layers of the adrenal cortex? secondary adrenal insufficiency results in loss of which layers of the adrenal cortex? would hyperpigmentation be seen in primary or secondary?

all three layers - addison disease (autoimmune destruction) zona glomerulosa remains intact - aldosterone unaffected and volume and potassium are normal. primary - bronzing of the skin and sparse body hair

what type of wound care dressing is highly absorbent that is made from seaweed that osmotically dries out wounds, and has a hemostatic effect for donor sites postsurgically?

alginate - kaltostat, alginate, sorbsan, algiderm.

what type of wound care product is safe under compression, and its primary function is absorption and packing?

alginates - aquacel, Nu-derm, sorbsan

what is the treatment for a NSTEMI? what is the treatment for a STEMI?

all get aspirin, nitro, beta blocker, ACE med, oxygen, morphine. NSTEMI patients get IV heparin if procedure planned, or LMWH if no procedure planned. STEMI patients get thrombolysis with tPA (no benefit for NSTEMI) most effective if given within 6 hours, though can be given up to 12. PLUS all get immediate coronary catheterization within 90 mins if possible.

eosinophils are generally involved in? would be increased in?

allergic and immune responses NAACP (neoplasm, allergy, addison's collagen vascular disorder, parasites)

what wound care dressings provide absorption, and prevent periwound maceration, with adhesive borders?

allevyn, softfoam, polymem, tielle

if a patient has an OCD that is 1.5cm-3cm, and is under 50 yrs what would you use to treat it?

allograft or (OATS)

what type of oral diabetic medication works by reducing the intestinal carbohydrate absorption?

alpha glucosidase inhibitors - acarbose/precose, and miglitol/glyset.

target cells in a peripheral smear would indicate what type of anemia? what type of anemia is that?

alpha thalassemia microcytic hypochromic four alpha alleles: if all four deficits = Hgb Barts (hydrops fetalis due to gamma tetramers)

best initial treatment for fibromyalgia?

amitrityline

augmentin what is the dose? how much clavulonic acid in each dose? what is the indication? what is the spectrum of activity? does it cover pseudomonas?

amoxacillin/clavulonic acid 500 or 875 125 mg in each PO antibiotic for polymicrobial infections staph, strep, enterococci, gram negs, anaerobes. yes

what is the drug of choice for enterococcus?

amoxicillin or vanc

describe the weil procedure.

an intra articular osteotomy beginning at the most dorsal distal aspect of the articular cartilage and ending at the proximal base parallel to the weight bearing surface.

what type of thyroid cancer is most common in elderly and directly invades the head and neck?

anaplastic carcinoma

what type of anemia is diagnosed by bone biposy showing macrophages that stain densely with Prussian blue. what type of anemia is that?

anemia of chronic disease microcytic hypochromic

what are the three bone tumors that have a soap bubble appearance radiographically?

aneurysmal bone cyst giant cell tumor chondromyxoid fibroma

Benin, expansile, lytic lesion with blood-filled cavities?

aneurysmal bone cyst - soap bubble appearance. finger in a balloon term.

is relieved by rest, and sublingual nitro in a few minutes?

angina

Which joint surface bears more weight than any other joint surface in the body?

ankle joint/talar dome

what radiographic view is best for visualizing the trochlear surface of the talus and its articulation with the tibia and fibula?

ankle lateral

what radiographic view is best for visualization of the tibiofibular syndesmosis? for the talofibular joint?

ankle medial oblique ankle medial oblique

a chronic inflammatory arthritis of the sacroiliac joints. what test can be used to diagnose it?

ankylosing spondylitis positive schober test and HLA-B27

a young man has low back stiffness in the morning for more than 1 hour that is relieved with activity. what is indicated?

ankylosing spondylitis - HLA B27 positive also get anterior uveitis, aortic valve insufficiency, and heart block best initial test is xray most specific test is MRI best initial treatment is NSAIDs and activity

what type of gait is seen when limping to avoid pain?

antalgic gait

what radiographic view is best for visualization of the tibial plafond and medial gutter?

anterior drawer/ push pull test positive is 6mm or more of gapping from the posterior lip of the tibia and the nearest part of the talar dome.

the majority of epistaxis is from?

anterior from kiesselbach plexus

in congenital vertical talus/convex pes planovalgus/rocker bottom flatfoot, the STJ facets are affected in what way?

anterior is absent middle is hypoplastic posterior is malformed or misshapen

osteochondral lesions of the talar dome are commonly found where?

anterior lateral or posterior medial aspects

what is the most medial muscle of the anterior compartment of the leg?

anterior tibial

a early diastolic murmur that is a decrescendo, blowing, and high pitched and is louder sitting forward and after exhalation in the 3rd left intercostal space would be?

aortic regurgitation

what valvular heart condition has pulsus parvus et tardus?

aortic stenosis

a early diastolic, crescendo - decrescendo murmur that has an ejection click and an S4 would be?

aortic stenosis - pulsus parvus et tardus

what is a disorder of multiple bony coalitions?

apert syndrome

what is the pinpoint bleeding that occurs when a scale is removed? what condition is this associated with?

auspitz sign psoriasis - salmon pink papules or plaques covered by silvery scales.

What type of bone graft is osteogenic, osteoinductive, and osteoconductive?

autograft

does an allograft, an autograft or both have cellular bony matrix? does an allograft, an autograft or both have osteoinductive properties does an allograft, an autograft or both allow creeping substitution? does an allograft, an autograft or both have fast healing times?

autograft does, allograft doesn't autograft does, allograft doesn't both do autograft is faster than allograft

what type of neuropathy causes xerosis of the skin?

autonomic neuropathy

MEN syndromes have what inheritance?

autosomal dominant

talar neck fracture from a forced dorsiflexion of the foot on the ankle is called?

aviator's astragulus

what are behrens principles of external fixation?

avoid and respect neurovascular structures allow access to injured area for future fixation meet mechanical demands of the patient and injury

what is the best treatment for pneumonia?

azithromycin plus beta lactam like ceftriaxone. fluoroquinolone will also work if PCN allergy or needing once a day dosing.

what antibiotics cover pseudomonas?

aztreonam aminoglycosides cipro ceftazidime cefepime timentin zosyn

signs of UMN lesion are? signs of LMN lesion are?

babinski, clonus, hyperreflexia, spasticity, spastic paralysis. atrophy, hyporeflexia, hypotonicity, flaccid paralysis, fasciculations.

what are the aerobic gram positive rods?

bacillus anthracis corynebacterium diphtheriae listeria monocytogenes

what are the anaerobic gram negative rods?

bacteriodes fragilis

what organism causes cat scratch disease?

bartonella henselae

when doing a lumbar puncture, how would you determine between a bacterial and a tuberculosis and a viral infection?

basically all have a low glucose, all have variably high WBC count with bacterial the highest. proteins are higher than 250 in bacterial and tuberculosis, and 50-250 in viral. normal glucose 50-75, protein 15-45, and WBC 0-5

what is the first branch of the lateral plantar nerve?

baxter nerve - calcaneal pain after activity, not first step in the morning.

what is used after serial casting for metatarsus adductus in a child?

bebax shoe - not for primary correction

what is the ideal time frame for fixating calcaneal fractures?

before 5 hours, or delayed to 7-10 days when swelling subsides. ALWAYS before 3 weeks

is the term "expansile" when referring to bone tumors more likely a malignant or benign tumor? why?

benign malignant tumors grow too fast to be expansile

what are the characteristics of ossifying fibroma?

benign bone forming tumor occurs during 2nd-4th decade most common in the mandible. lesions are asymptomatic intracortical osteolytic lesions with ground glass appearance with bubbly area clearly delineated by a band of sclerosis.

what are the characteristics of chondromyxoid fibroma?

benign cartilaginous tumor 2nd and 3rd decades slowly progressing pain and swelling radiographic appearance of eccentrically located radiolucent lesion that is lobulated/bubbly with sclerotic, well developed margins.

how would you tell an arterial vs venous ulcer?

arterial would usually be distal to the medial malleolus, have little drainage, irregular skin borders, deeper punched out(rounded) appearance. venous would usually be proximal to the medial malleolus, moderate/severe drainage, well rounded skin borders, and shallow irregularly shaped appearnce.

what other deformity is most common to see in congenital vertical talus/convex pes planovalgus/rocker bottom flatfoot?

arthrogryposis (congenital joint contractures)

how long after putting in internal fixation into a patient should you wait to perform an MRI?

at least 6 weeks

where is any tendon most likely to rupture or have disease?

at the point at which it changes direction (the angle) PT - medial malleolus peroneals - lateral mal anterior tib - at the ankle joint behind the retinaculum etc.

what type of gait has marked instability in single limb stance with alternating wide and narrow base of gait. swing phase has the one limb swing widely across the midline. what is this seen in?

ataxic gait MS, tabes dorsalis, diabetic polyneuropathy, friedreich ataxia

narrow complex on EKG means? wide complex on EKG means?

atrial ventricular when speaking about non sinus rhythm EKGs

what type of EKG cardiac rhythm shows multiple atrial foci depolarizing in a chaotic manner (irregularly irregular)?

atrial fibrillation

what type of EKG cardiac rhythm shows a sawtooth pattern of ectopic atrial beats?

atrial flutter

a systolic murmur with splitting of S2 would be?

atrial septal defect

what type of atrophic non union has non osteogenic scar tissue that fills the void?

atrophic

what are the two types of charcot arthropathy?

atrophic and hypertrophic

patient presents with somnolence, confusion, and respiratory depression. what drug overdose? how do you treat it?

benzos flumazenil

what procedure for the correction of metatarsus adductus is a laterally based crescent osteotomy of all met bases?

berman and gartland

what disorder has a defect in GP1b that prevents platelets binding to vWF? how is it diagnosed?

bernard soulier syndrome diagnosis with giant platelets on peripheral smear

what type of anemia is due to an elevated Hgb A2? what type of anemia is that?

beta thalassemia microcytic hypochromic

as gait cadence increases, stance time increases/decreases, and swing time increases/decreases.

both decrease.

an S3 is heard loudest at which point? an S4?

both heard loudest at the mitral area - which is the area of cardiac apex

what are the most common sources of metastatic bone tumors?

breast, lung, prostate, kidney, thyroid

hyperpigmented macules on the trunk and legs diffusely could indicate?

cafe au lait spots - indicative of neurofibromatosis

patient presents with a three week duration of black lesion on her heel. what is the most likely diagnosis?

calcaneal petechiae/talon noir/black heel - extravasation of RBCs caused by shear force

what is a pseudoequinus due to?

cavus foot type - apparent equinus but not actually one.

what is the best cephalosporin for strep?

ceftriaxone/rocephin

dermoscopy shows pebbles on a ridge pattern, what is indicated? dermoscopy shows peas in a pod pattern, what is indicated?

calcaneal petechiae/talon noir/black heel - extravasation of RBCs caused by shear force congenital melanocytic nevi both can be mistaken for melanoma

what type of coalition is always asymptomatic?

calcaneocuboid coalition CC

a basic, and fundamental tenet of the ponseti method is that the clinician should never touch which bone in manipulation?

calcaneus

what are the two most common bones for primary bone tumors in the foot?

calcaneus metatarsals

would a callus have pain on direct pressure or lateral pressure squeezing? a wart?

callus - direct pressure wart - lateral squeezing

what is the least common type of hyperdactyly?

central polydactyly

scissor gait would often be seen in?

cerebral palsy - due to adductor spasticity

what other condition besides osteoporosis can bisphophonates be used for?

charcot inhibits the molecular pathway - inhibits RANKL can be asssoc. with osteonecrosis of the jaw IV bisphosphonate is reclast.

what tumor has a chicken wire calcifications?

chondroblastoma

peripheral blood smear shows lymphocytosis and smudge cells.

chronic lymphocytic leukemia (CLL)

DOC for aeromonas?

cipro

what is the equation to measure the creatinine clearance and estimated GFR?

cockcroft gault

pneumatic power instruments are driven by? electric power instruments? battery instruments?

compressed nitrogen alternating current direct current

what describes the process by which the edges of a wound pull toward the center of the wound to close it?

contracture

what is the procedure done intraoperatively to diagnose syndesmosis injury? how do you interpret this test?

cotton hook test if you pull the fibula and you see a 3-4 mm lateral shift on radiographs its a positive test for syndesmosis instability. fixate it

what is reglan used for?

decreased gastric motility

what type of splint/bar is screwed or riveted to the child shoes? which clamps to the rigid sole of the shoe?

denis browne bar fillauer bar

what layer of the skin has the blood vessels, lymphatics, nerve endings etc.?

dermis

What is orthofix? What is orthosorb?

dexon PDS

for a high pitched murmur you would use what part of the stethoscope? for a low pitched murmur?

diaphragm bell

What are the safest NSAIDs for a patient with asthma?

diclofenac

what type of bone stimulator is a surgically implanted device? the cathode goes on the _______ and the anode goes on the ________.

direct current - invasive cathode on the bone and anode on the skin. disadvantages are surgical procedure, potential for short circuit, and limited battery life (6-8 months)

patient has bleeding from multiple body sites, and IV lines, mucosal surfaces, with decreased fibrinogen, elevated PT, and PTT with increased d dimer.

disseminated intravascular coagulation (DIC)

when diagnosing a peroneal nerve injury by use of a nerve block, would you block the proximal or distal nerves initially?

distal initially then proximal to determine where the lesion is

a derotational arthroplasty skin incision is made in what direction?

distal medial to proximal lateral

older patient with left lower quadrant (LLQ) colicky pain and tenderness for several days.

diverticulitis

diverticulosis or diverticulitis would have sudden onset of bright red blood in the stool?

diverticulosis

levothyroxine replacement does or does not cause weight loss?

does not celiac disease is assoc. with poor levothyroxine absorption.

what are the approaches for fasciotomy of the foot?

dorsal approach - 2 incisions over the 2nd met and 4th met to get all compartments except the calcaneal. medial approach - medial plantar incision to get the calcaneal compartment.

are the plantar or dorsal interossei bipennate in their origin?

dorsal interossei

what is the planes of motion available at the 1st ray?

dorsiflexion with inversion plantarflexion with eversion frontal and sagittal plane motion.

what are the hydrocolloids wound care products?

duoderm, safe-gel, CGF patch, dermacol, hydrocol.

the protein binding characteristic of a drug will affect the?

duration of action

What type of bacteria is gonorrhea? What is gonorrhea cultured on? What is the treatment for gonorrhea?

gram neg diplococci chocolate agar ceftriaxone

what is the normal value for a nerve conduction velocity test NCV?

greater than 40 mps (meters per second)

what is a hyperkeratotic lesion of the interspace of a toe?

heloma molle - usually the 4th

each unit of transfused blood should increase the hematocrit by _____, and the hemoglobin by ______

hematocrit by 1 (the ratio of the volume of red blood cells to the total volume of blood) hemoglobin by 3 (The amount of the hemoglobin molecules in a volume of blood)

what are the primary reasons for graft failure?

hematoma - most common infection - second seroma shearing - movement poor wound bed - poor vascularity or exposed tendon or bone.

what is a type of block you can perform when performing a closed reduction of a fracture?

hematoma block - inject the ankle with 20cc of lidocaine plain to insufflate the joint and provide analgesia

What is a martini sign?

histology showing a glucophage engulfing a gout crystal

biopsy shows reed sternberg cells.

hodgkin lymphoma

if you increase the kVp you will increase/decrease the contrast? will the image appear white or black? is this due to over or under penetration?

increase the kVp, decrease the contrast, less greyscale and black image. due to overpenetration therefore if you decrease the kVp, you increase the contrast

what is hoffa's sign?

increased dorsiflexion compared to the contralateral side along with inability to perform a single heel rise test. - achilles rupture

how does lamisil/terbinafine work?

inhibits ergosterol synthesis

what is a bier block?

injecting anesthesia into a vein which will travel down and diffuse in to the surrounding nerves. a tq is placed around the area where you want the block to occur, then anesthesia injected into the closest vein and the anesthetic diffuses. once the tq is released the block will disappear shortly after.

what is a CAM walker with plaster or fiberglass cast material wrapped around it?

instant Total contact tast or iTCC

an overweight female who complaints of continuous headaches and MRI shows an invagination of the diaphragm of the subarachnoid space into the pituitary tissue.

empty sella syndrome - sella appears not to contain pituitary tissue buts its function remains intact.

an expansile, lytic, oval lesion in the proximal phalanx of a 35 year old female is most likely?

enchondroma

what is the most common tumor of the phalanges of the foot?

enchondroma

what are some possible treatments for tibialis posterior tendon rupture?

end to end repair FDL tendon reinforcement - FDL sutured to the PT, and the distal aspect sutured to the FHL.

splinter hemorrhages, osler nodes, roth spots, and janeway lesions are signs of? which are painful?

endocarditis janeway is not painful osler nodes are painful

what is the loose acellular tissue carrying blood vessels that surround the small bundles of collagen in the tendon?

endotenon

This is a benign lesion which arises from reticuloendothelial system (RES) during the first decade of life. Known as "Langerhan's cell histiocytosis"

eosinophilic granuloma Classic "punched-out" borders appearing radiolucenies on radiograph

when using halothane, what drug is contraindicated?

epi

what is the treatment for anaphylaxis?

epi 0.3-0.5 ml subQ of a 1:1000 solution

which IV anesthetic has the potential complication of adrenal insufficiency?

etomidate

what happens to a hematoma that has walled itself off from surrounding tissue?

eventually will clot and form a large scar

Aggressive, permeative, lytic lesion with hair-on-end, Codman triangle, and onion skin?

ewings sarcoma

what is the most reliable clinical test for diagnosing syndesmosis ligament injury?

external rotation test dorsiflexion and external rotation of the foot with stabilization of the leg.

Benign, geographic, fibro-osseous lesion with ground glass matrix?

fibrous dysplasia

what is the treatment for alcohol overdose?

fomepizole

what is the most common presenting symptom of CMT?

foot drop followed by cavus foot, and then hammertoes. progressive distal to proximal weakness

what is the correct position of the foot for ankle fusion/arthrodesis?

foot is 90 deg to the leg in sagittal plane foot is 0-5 deg of valgus 10-15 deg of external rotation (2nd ray aligns with tibial crest)

what is the treatment algorithm for tetanus prone wound? what are the dosages?

for any clean wound, except in the case of recent tetanus vaccination (5 yrs), give the toxoid but hold the TIG. for any dirty wound, except in the case of recent, tetanus vaccination (5 yrs), give the toxoid and the TIG. for recent tetanus vaccination, you do not give either for both clean and dirty wounds. Toxoid: 0.5ml TIG (tetanus immunoglobulin): 250-300 units

what are the diabetic medication recommendations for NPO status?

for type 2 - half the normal dose of long acting, check glucose every 6 hrs with short acting available if needed. for type 1 - insulin drip, half of normal dose of long acting agent. check every 6 hrs.

how would you diagnose a tarsal tunnel syndrome?

forced eversion of the foot. tinel's sign/valleix sign. turk's test - inflation of a tq over the ankle PT nerve block will be a diagnostic block treat with orthotics to control pronation, or surgical release.

in congenital vertical talus/ convex pes planovalgus/ rockerbottom flatfoot, what is the position of the forefoot and the calcaneus?

forefoot is abducted and dorsiflexed calcaneus is in valgus and equinus

in a medial oblique view/lateral oblique projection, where is the target of the xray beam?

fourth met cuboid articulation

what is a chronic inflammatory/auto immune disease of myelin sheath destruction in the CNS seen in young females in the northern hemisphere?

multiple sclerosis - diagnosed with MRI, or spinal tap with WBCs with IgG oligoclonal bands. first symptoms between 20-40 - diplopia and optic neuritis avoid heat (baths, jacuzzis)

charcot was first described by?

musgrave in 1703 but named for jean martin charcot in 1868

what are the requirements for fluoroscopy for safety?

must have a dead man's switch must shut off after 5 mins straight. must have .25mm of lead protection.

what disease is diagnosed with the acetylcholine receptor antibodies test?

myasthenia gravis - autoimmune antibodies to acetylcholine destroy the neuromusular junction

what is a benign reactive lesion of striated muscle resulting from trauma?

myositis ossificans

supraventricular tachycardia would result in narrow or wide QRS complexes? ventricular tachycardia would result in narrow or wide QRS complexes?

narrow - if P waves are present its definitely supraventricular wide - if sustained for more than 30 secs will convert to v fib.

what are the primary indicators of a non aggressive bone lesion?

narrow zone of transition geographic pattern of destruction no periostitis of adjacent soft tissue sclerosis surrounding the normal bone

when does midstance phase begin?

opposite side toe off

what is a deep heating modality that can heat structures to a depth of 2-5cm

short wave diathermy

what is inflammation of the cortex of bone?

osteitis

Who was the first to describe an arthrodesis?

soule

what are the neck osteotomy procedures for the 1st met?

peabody hohmann wilson DRATO Mitchell

what drug can be used for tophaceous gout? for chronic gout? for acute gout?

pegloticase/krystexa allopurinol/febuxostat 1st - NSAID, 2nd - colchicine

what adverse reaction can toradol cause?

peptic ulcer

what are the connective tissues associated with the tendon (epitenon, endotenon, mesotenon etc)

peritenon

patient presents with the uvula pushed past midline, what is indicated?

peritonsilar abscess

for a punch biopsy the skin should be stretched taut in what direction?

perpendicular to the relaxed skin tension lines

what is the antidote for atropine/anticholinergics overdose?

physostigmine

hard black nodules that form on the hairs of the scalp or beard are called?

piedra - piedraei hortai

flat, oval salmon colored lesion that arise from a herald/mother patch on the back that radiate from the spinal column (christmas tree pattern) would be consistent with?

pityriasis rosea - spares the palms and soles of the feet.

painful unrepairable nerve segments are best treated by?

placement of the cut nerve end into muscle or bone.

does MRI or plain film radiograph have a higher specificity for OM?

plain film radiographs per Termaat in JBJS 2005

Does a neuroma lie dorsal or plantar to the deep transverse intermetatarsal ligament?

plantar

what radiographic view is good for demonstrating the sesamoids and plantar aspect of the metatarsal heads?

plantar axial head angled at 90, toes dorsiflexed and heel raised.

what is the spring ligament?

plantar calcaneonavicular ligament

what is the origin/insertion and twisting of the fibers of the gastroc and soleus?

plantaris originates laterally and inserts medially gastroc originates both medially and laterally and inserts central soleus originates globally on the posterior leg and inserts laterally creates a wringing action/internal rotation of the muscle for blood flow

how would you diagnose primary vs secondary hyperaldosteronism?

plasma renin high aldosterone, and low renin - primary high aldosterone, and high renin - secondary aldosterone to renin ratio while supine and hydrated. ratio >30 is primary ratio of <10 is secondary

Web located in the upper esophagus due to esophagitis, iron deficiency, bullous skin disorders, and pemphigus vulgaris.

plummer vinson syndrome

what diagnosis is JAK2 positive?

polycythemia vera

comminuted fractures of the talar body have poor long term outcomes and are best treated with?

possible talectomy definitely tibial-talo-calcaneal fusion (TTC) blair fusion can be used - slide the anterior portion of the tibial down into the talus as a graft and fuse it.

when performing soft tissue procedures for clubfoot, what are the choices?

posterior, medial or lateral release

what is the most important lab to look at prior to surgery?

potassium normal range→ 3.5-5 mEq

what are the three stages of AVN?

pre collapse - asymptomatic collapse - significant pain and stiffness arthritis - pain and stiffness with joint narrowing/sclerosis.

an external fixator will have the greatest amount of bone repair if it has what characteristics?

prevents bending, and torsion. allows small amounts of axial movement

what is the most common secretory pituitary tumor?

prolactinoma

what action will contribute to unlocking of the knee joint during the gait cycle?

pronation of the subtalar joint STJ

what is the motion of the longitudinal axis of the midtarsal joint? what is the motion of the oblique axis of the midtarsal joint?

pronation/supination, predominantly frontal plane. pronation/supination, predominantly sagittal and transverse plane.

the radiographic pencil in cup deformity at the interphalangeal joints is diagnostic of?

psoriatic arthritis - or whittling of the distal tufts of the phalanges.

tendons, ligaments, and joint capsules heal by what means?

lag, fibroproliferative, and maturation phases. lag - 2 weeks, enhanced by immobilization fibroproliferative - week 3, marked increase in fibroplasia, gentle passive motion exercises. maturation - 4 weeks on, moderate strength, progressive strengthening and active exercises.

what is the underside of the head of a screw which contacts the near cortex unthreaded portion of the screw what represents the weakest portion of the screw?

land shank run out - junction between the shank and the threads.

what procedure for the correction of metatarsus adductus is a capsulotomy of the 1st met cuneiform joint with division of the abductor hallucis?

lange

what are some clinical features of acromegaly?

large hands and feet frontal bossing deep voice carpal tunnel HTN

what is the classification scheme for lateral ankle ligament trauma?

leach I - ATFL II - ATFL and CFL III - ATFL, CFL, and PTFL O'donaghue, Dias

at what length does a muscle generate the most force?

resting length

patient sits in the sniffing position, with fever, and looks toxic. what is indicated?

retropharyngeal abscess

ventricular tachycardia is treated how?

stable and asymptomatic - IV amiodarone unstable - cardioversion

during what stage of anesthesia is it appropriate to elevate an extremity tourniquet?

stage II

what is the strongest suture with the longest absorption rate? What are the two sutures that are the least reactive to tissue?

stainless steel stainless steel, prolene

what are the aerobic gram positive cocci?

staph strep MRSA MRSE enterococcus VRE

Web located at the gastroesophageal junction.

schatzki ring or steakhouse syndrome

what is an absolute contraindication to an opening wedge osteotomy for hallux abducto valgus deformity?

long first metatarsal - since it lengthens it

what is the cause of gastroparesis?

long term poorly controlled DM type II

what procedure performed for sagittal plane flatfoot deformity, is a plantarflexory talonavicular wedge arthrodesis with a TAL?

lowman the tib ant is rerouted under the navicular to the spring ligament

what is the score for classifying necrotizing fasciitis?

lrinic score based on a point system, over 6 = 92% positive CRP ≥150: 4 points WBC count 15-25: 1 point >25: 2 points Hemoglobin 11-13.5: 1 point, <11: 2 points Sodium <135: 2 points Creatinine >1.6: 2 points Glucose >180: 1 point

young woman with malar rash and ANA positive.

lupus discoid rash raynauds jaccoud's arthropathy

what type of ulcer can eventually become a squamous cell carcinoma? what is this ulcer most commonly associated with?

marjolin's ulcer- assoc. with chronic OM burn wound

on xray what would you see for gout?

martel sign rat bite erosions overhanging margins

what arthroplasty procedure is excision of 2/3 of the metatarsal head?

mayo-Hueter

what procedure for the correction of metatarsus adductus is an arthrodesis of the 1st met cuneiform joint and osteotomy of 2-4.

mccormick and blount

what are the three branches of the posterior tibial nerve?

medial and lateral plantar medial calcaneal nerve

The anterior facet is best seen by which radiographic views?

medial oblique, isherwood

Single transverse white band in the nail associated with arsenic poisoning

mees lines

what type of skin lesion is a shave biopsy not indicated for?

melanoma - due to depth

the cardiac apex correspond with which area of heart sound ausculatation?

mitral

what suture technique is best for closure of a lateral extensile approach to calcaneal fracture fixation?

modified denotti suture - especially for that corner *always good to follow up with some form of compression bandage*

What is the Bassett ligament?

most inferior extension of the Anterior inferior tibiofibular ligament - *intra capsular*

Which screw in a 1st MPJ fusion plate is most likely to cause a stress fracture?

most proximal one

what is a radiograhic sign when looking for middle facet subtalar joint coalitions?

rounding of the lateral process of the talus C sign, or halo sign talar beak sign - flaring of the superior margin of the talar head shortening of the talar neck ball in socket page 434 in watkins shows all of these

what flatfoot plane of dominance is the hoke procedure performed for?

sagittal plane

what flatfoot plane of dominance is the lowman procedure performed for?

sagittal plane

what flatfoot plane of dominance is the miller procedure performed for?

sagittal plane

what flatfoot plane of dominance is the young keyhole procedure performed for?

sagittal plane

what power saw cuts in the same plane as the instrument? what is its arc of excursion? what power saw cuts perpendicular to the instrument? what is its arc of excursion? which is better for longer and deeper cuts?

sagittal saw 4 deg. arc oscillating saw 7 deg arc sagittal saw

OM that presents with hemoglobulinopathy would most likely be from what bug?

salmonella

what is a dressing specifically designed for skin grafts?

stent dressing

if you have cellulitis and it has streaking would it be staph or strep?

strep - deeper usually staph has no streaking.

what is the first sign of malignant hyperthermia?

tachycardia

How to determine if patient is an overproducer or underexcretor?

take a 24 hour urine sample

what is the most common coalition of the rearfoot?

talocalcaneal then CN bar, then talonavicular

what are the surgical options for lesser digital hammertoes?

tenotomy extensor tendon lengthening capsulotomy arthroplasty/arthrodesis flexor tendon transfer syndactyly

what is the treatment for reactive arthritis/reiter syndrome?

tetracycline and NSAIDs

what is the treatment for lyme's disease?

tetracyclines

in a V-Y skin plasty what part of the skin flap is placed at the point of maximal skin tension?

the apex of the V

Current histological classification of soft-tissue tumors is based on what?

the apparent differentiation of the tumor cell

what structure helps maintain the orientation of the EDL and EDB?

the extensor hood and sling

at what stages do vessels penetrate the long bones growth plates? at what stages is joint sepsis possible?

the infantile and adult stages infantile stage

why does renal disease cause osteoporosis?

the kidneys are not functioning to phosphorylate the vitamin D to absorb calcium.

what is the weakest point of a tendon repair with krackow stitch?

the knots tied in the middle

what is always the mechanism of injury for calcaneal fractures.

the lateral process of the talus is driven down into the neutral triangle of the calcaneus.

the effects of radiation on tissues depend on what?

the proliferative capacity, and the differentiation.

full thickness skin grafts do or do not preserve the hair follicle?

they do

what nerves are most susceptible to neuropraxia?

thickly myelinated, large diameter, rapidly conducting.

which shoe modification is best for reinforcing the medial arch?

thomas heel

DOC for superficial thrombophlebitis?

timentin

what are the complications associated with tourniquet use?

tissue necrosis inflammation paralysis thrombosis circulatory volume overload pain

what can be used to avoid scatter on MRI so that talar AVN can be evaluated following a fracture?

titanium hardware

IL-6 inhibitor? JAK inhibitor? RANKL inhibitor?

toculizumab tofacitinib denosumab - possible use for acute charcot

what does a normal synovial joint fluid analysis reveal?

transparent colorless fluid that has glucose levels equal to blood, less than 25 PMNs, less than 200 WBC, and a high viscosity.

what flatfoot plane of dominance is the kidner procedure performed for?

transverse plane

in moncheburg's sclerosis the extensive deposits of calcium in the arteries occurs in which layer?

tunica media

what is characteristic of a transverse plane flexible flatfoot condition?

uncovering of the talar head absence of calcaneal eversion no medial column failure abduction of the lateral forefoot

what are the causes of hallux varus?

underlying causes: long 1st met round 1st met head 1st MPJ hypermobility iatrogenic causes: staking of the 1st met head - most common overcorrection of IM angle overzealous medial capsulorraphy fibular sesamoidectomy over extensive lateral release overcorrection of PASA overzealous bandaging

what are the only FDA approved drugs for MRSA?

vanc linezolid daptomycin tigecycline telavancin

what type of gait has a high step rate, increased lateral trunk movement, scissoring, and instability.

vaulting gait

what is the classification scheme for posterior tibial fractures?

volkmanns A - large intra articular >25% with displacement B - small intra articular <25% without displacement C - small fracture without displacement D - avulsion fx

When multiple cutaneous lesions are noted along with café au lait spots, the condition is called?

von recklinghausen disease

what type of gait has a laboring gait with difficulty with balance proximal pelvic instability, and leads to lumbar lordosis. what is this seen in?

waddling gait muscular dystrophies, congenital dislocated hip

what is the cause of a white toe post operative? what are the steps to resolve it?

white toe - arterial in order of first tx to last. place foot in dependent position loosen bandage twist the K wire apply heat to small of back PT block remove K wire remove dressing and open wound.

what total matrixectomy involves three skin flaps sutured together?

whitney

Can local anesthetics cross the placental barrier?

yes

oul-smelling breath with oral regurgitation and coughing during meals, and aspiration pneumonia

zenker diverticulum surgical repair

What is the cross-reactivity of cephalosporins and PCN?

1-10%

What is a Bakers cyst?

Swelling of the bursa between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles

what are the ages of coalition fusion/onset of symptoms?

T-N (3-5 years) C-N (8-12 years) T-C (12-16 years)

putter sign would indicate what?

T-N coalition in which neck of talus unites with broad expansion of navicular

Should a plate be placed on the tension or compression side of a fracture?

Tension

What NSAID does not inhibit platelet aggregation, and is the best NSAID for history of GI bleed?

The COX-2 inhibitor, Celebrex

what are the spirochetes?

Treponema pallidum Borrelia burgdorferi

true/false the medial displacement calcaneal osteotomy reestablishes the achilles tendon as an inverter. true/false the medial displacement calcaneal osteotomy produces a tightening effect on the plantar fascia.

True - moves the center of pull more medial and therefore inverts the foot. False - actually loosens the plantar fascia.

When should aspirin be discontinued prior to surgery? When should NSAIDs be discontinued prior to surgery? When should heparin be discontinued prior to surgery? When should Coumadin be discontinued prior to surgery?

7 days due to irreversible binding to platelets 3 days due to reversible binding to platelets 8 hours (monitor PTT) 3-4 days (monitor PT/INR)

what is the average angle of gait? what is angle of gait defined as?

7 deg toe out per side - cumulative 14-15 deg total the angle formed by the longitudinal axis of the foot and the line of progression (the direction of step)

what is the normal intermetatarsal 4-5 angle? what is the normal lateral deviation angle?

7 deg, pathologic is >9 3 deg, pathologic is >8

what is the normal PASA and DASA angles?

7.5

the most common podiatry probe for diagnostic ultrasound is?

7.5 mHz and can penetrate up to 7cm deep.

How much lengthening can be achieved with a 60° Z-plasty? To correct a skin contracture, how should the Z-plasty incisions be oriented?

75% The central arm of the Z should be parallel to the contracture

Longitudinal midtarsal joint Oblique midtarsal joint

75° from frontal plane 15° from transverse plane 9° from sagittal plane 57° from sagittal plane 52° from transverse plane 38° from frontal plane

what are the osseous procedures for correction of metatarsus adductus? at what age are these procedures done?

8 and older berman and gartland lepird johnson osteochondrotomy fowler peabody-Muro steytler and van der walt mccormick and blount

probing to bone has _________ percent predictive value for OM. what paper proved this? also not probing to bone has a _________ percent predictive value for not being OM. what paper proved this?

89%, Grayson, 1995 98%, Lavery, 2007

how many bones in the tarsometatarsal joint/lisfranc joint? how many joints/articulations? dorsal ligaments? plantar ligaments? interosseous ligaments?

9 bones 13 joints 7 weak dorsal 5 strong plantar 1 lisfranc ligaments and 2 interosseous ligaments

accordingto pinzur, what 3 essential elements are required to heal a diabetic amputation and can be correlated to any diabetic wound?

ABI of <0.5 total lymphocyte count of 1500 serum albumin of >3.5 3 factors present is 92% rate of healing. 2 factors 37.5%

compressive therapy is contraindicated in what patient populations?

ABI of less than 0.8 CHF with an EF of less than 35% stents in the legs

what meds reduce preload and afterload in CHF patients and decrease mortality in patients with an ejection fraction <40%? when would you stop this medication?

ACE inhibitor stop ACE Inhibitor if the creatinine increases 30% above baseline, or if you see hyperkalemia, or if you experience a cough (switch to ARBs)

what drugs decrease mortality in patients with CHF?

ACE inhibitors beta blockers spironolactone AICD - Automated Implantable Cardioverter-Defibrillator - can decrease mortality in patients with EF <35%

what are the ligaments that make up the ankle joint?

AITFL, PITFL, IOTFL (interosseous tibfib ligament), syndesmosis (inferior transverse tibiofibular ligament)

For diabetic patients, who gets diabetic ketoacidosis and who gets diabetic coma? what is the main difference in symptoms/labs?

Type I (IDDM) - DKA Type II (NIDDM) - coma (hyperosmolar nonketotic coma HONC) DKA - metabolic acidosis, with >250mg/dl hyperglycemia HONC - hyperglycemia >600-1000mg/dl, and alkalosis.

how would you decide whether to hospitalize someone with bronchitis, pneumonia and influenza?

Use the CURB-65 criteria when you must decide on hospital admis- sion: confusion, uremia, respiratory rate (>30), low blood pressure, or age ::?:65 years

What antibiotics can be safely used with PMMA beads? why? how much antibiotic per cement?

Vancomycin, gentamycin, tobramycin, cefazolin The curing of PMMA is exothermic, therefore the antibiotic must be heat stable and hydrophilic. 2-4g per 40g of cement. *antibiotic beads achieve 200x the concentration compared to IV*

What are causes of macrocytic, megaloblastic anemia? what are the most common causes of each? what is the best initial test?

Vitamin B12 - vegan diet or small bowel disease folate deficiency - alcoholics and elderly peripheral smear shows hypersegmented neutrophils. tests will show methylmalonic acid and homocysteine.

What is the difference between a Vogler, Kalish, and Youngswick?

Vogler - offset V (apex at metaphyseal-diaphyseal joint) Kalish - long-arm Austin with angles of approximately 55° for screw fixation Youngswick - Austin with a slice taken dorsally to allow decompression and plantar flexion

joint aspiration in diagnosis of a type of arthropathy is made primarily on?

WBC count - 5-50k cells - inflammatory >50k cells - septic

what are the SIRS criteria?

WBC over 12k or under 4k, or 10% bands. Heart rate above 90 RR above 20 Temp above 100.4(38) or under 96.8 (36)

What are the stages of Raynauds Phenomenon?

White → blue → red Pallor - spasm of digital arteries Cyanosis - deoxygenation of blood pools Rubor - hyperemia

Can antibiotics affect PT/INR?

Yes. Antibiotics can affect normal flora, which alters Vitamin K. Therefore, the PT/INR can increase.

what procedure performed for sagittal plane flatfoot is a rerouting of the anterior tibial tendon through a keyhole in the navicular without detaching it from its insertion.

Young keyhole technique

what are some different TAL procedures?

Z plasty - Z lengthening and then sutured together hauser - 2/3 cut proximal and distal on opposite sides. white hoke - three cuts, two medial and one lateral (to avoid sural) conrad and frost - 2/3 cut on either side proximal and distal.

what are the steps for release of an overlapping 5th toe?

Z plasty or V-Y skin plasty Z tendon lengthening release of extensor hood capsulotomy plantar plate release plantar skin wedge excision

How to treat acute and chronic gout?

Acute: Colchicine NSAIDS Corticosteroids ACTH Chronic: Colchicine (prophylactically) Allopurinol Uricosurics - probenecid, sulfinpyrazone

What is the result of accidentally severing the quadratus plantae?

Adductovarus deformity of digits 4 and 5 as the pull of FDL is unopposed

what are the layers of the adrenal gland, and what does each produce?

Adrenal Cortex: Glomerulosa - aldosterone (mineralocorticoids) - actives renin angiotensin seystem and angiotensin II Fasciculata - cortisol (glucocorticoids) - neg feedback to hypothalamus inhibits CRH, and neg feedback to pituitary inhibits ACTH. Reticularis - androgens - neg feedback to hypothalamus inhibits GnRH, and neg feedback to pituitary inhibits FSH and LH. Salt Sugar Sex Adrenal Medulla: epinephrine - direct sympathetic control.

What are the advantages of using Lovenox vs. regular Heparin? Disadvantages?

Advantages - Lovenox has longer plasma half-life with significant anticoagulation in trough Disadvantages - increased post-op complications when used with spinal/epidural anesthesia

what are the two component total ankle implants? what are the three component devices?

Agility Eclipse INBONE Salto Talaris STAR

what procedures can be performed to correct DASA? what procedures can be performed to correct PASA?

Akin reverdin (all) Hohmann logroscino

what is a useful test to diagnose acute CHF exacerbation?

B-type natriuretic peptide (BNP) - levels <100 pg/mL

Intestinal columnar metaplasia of the distal esophagus secondary to chronic GERD

Barrett esophagus

patient has a pearly papule with surrounding telangiectasias, what is indicated?

Basal cell carcinoma - found on sun-exposed parts of the body most common skin cancer in caucasians/US

what is the Mangled Extremity Severity Score (MESS) based on?

Based on 4 criteria: Skeletal/Soft Tissue Injury Limb Ischemia Age Shock A score of 7+ has an increased likelihood of amputation.

what nerve is often implicated as a cause of inferior heel pain, usually after activity?

Baxter neuritis - first branch of the lateral plantar nerve. surgical options include decompression/neurolysis of the nerve Through a medial incision, bluntly dissect down to the superficial and deep fascia of the abductor hallucis muscle, perform a vertical incision through these structures, and remove a segment of these tissues. Follow the nerve plantarly, and resect a portion of the plantar fascia.

What should be given for an indomethacin overdose?

Benadryl - decreases serotonin and histamine release

What are characteristics of a giant cell tumor?

Benign but locally aggressive, lytic lesion with characteristic moth eaten appearance. cortex is eggshell thin. May destroy cortex and have soft tissue mass More common in females 3rd to 4th decades of life Painful may be assoc. with pagets disease

What are characteristics of nonossifying fibromas?

Benign connective tissue lesion with fibrous replacement of bone Expansive, radiolucent, medullary lesions with subcortical scalloped margin. 1st to 2nd decades of life Lesions typically resolve with age Do not biopsy

What are characteristics of a fibrous dysplasia?

Benign, geographic, fibro-osseous lesion with ground glass matrix Presents with deformity Sometimes painful 2° to fracture

What are characteristics of a unicameral bone cyst?

Benign, geographic, medullary lesion that is fluid-filled Commonly/Always found in calcaneus Fallen fragment sign - pathologic fracture in which cortex lies within lesion 1st to 2nd decades of life Asymptomatic until fracture

What are characteristics of a chondroblastoma?

Benign, geographic, osteolytic, lesion with sclerotic margins and stippled calcifications. may see hemorrhagic foci, and cystic blood spaces that can mimic aneurysmal bone cysts. 2nd to 3rd decade of life Pain and joint effusion

What are characteristics of an osteoid osteoma?

Benign, osteolytic lesion with *central radiolucent nidus* (<1 cm) that may have calcifications, and has a classic bulls eye appearance. most often in femur and tibia. 1st to 2nd decades of life Dull pain, worse at night, relieved with ASA or NSAIDs

What are characteristics of an enchondroma?

Benign, well-defined, intramedullary, cartilaginous lesion Geographic lesions with punctuate calcified matrix 3rd to 4th decades of life Painless swelling unless pathologic fracture

What are characteristics of an aneurysmal bone cyst?

Benin, expansile, lytic lesion with blood-filled cavities, described radiographically as fallen fragment sign. May extend into soft tissue Fluid-fluid levels seen on MRI 1st to 3rd decades of life More common in females must consider telangiectastic osteosarcoma

What is Integra? oasis? graftjacket?

Bilayer graft composed of bovine tendon collagen with chondroitin-6-sulfate and a silicone layer to control moisture loss Extracellular graft matrix derived from porcine, small intestine submucosa Extracellular graft matrix derived from human tissue with intact vascular channels

what is the girdlestone procedure? what are its indications?

a FDL transfer used to correct hammer toes that includes transecting it, splitting it and suturing it around the proximal phalanx. hammer toes

CT or MRI shows a ring enhancing lesion, it would indicate?

a brain abscess if HIV pos - pyrimethamine and sulfadiazine if HIV neg - aspiration of abscess plus broad spec cephalosporin and metronidazole

patients with an accessory navicular usually have?

a flexible flat foot

what does HAART therapy consist of? what patient population is it used for?

a non nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) plus two nucleoside reverse transcriptase inhibitors (NRTIs) used for HIV patients so basically: 1 NNRTI or PI + 2 NRTIs

what is the hibbs tendon transfer? what are its indications?

a transfer of the EDL tendon slips from their insertion on the distal phalanx of each digit, sutured together and reattached to the 3rd cuneiform or 3rd met base. equinus with or without claw toes the EDB tendons are transected and reattached to the stump of the corresponding EDL tendon with the 5th longus attached to the 4th brevis tendon.

what are the indications of Coronary artery bypass graft (CABG)

CABG instead of PCI should be done in the following settings: significant left main coronary artery disease >70% stenosis of the proximal LAD or LAC arteries. any three vessel coronary artery disease one or two vessel disease with <50% ejetion fraction

when using the ponsetti method for casting of clubfoot deformity, what is the order of correction of the deformity?

CAVE cavus forefoot adductus rearfoot varus equinus

if the ankle is dorsiflexed during an inversion ankle sprain, what ligament is injured? if the ankle is plantarflexed during an inversion? what is the most common ankle sprain?

CFL ATFL - 95% of sprains

What are components of CREST syndrome?

Calcinosis Raynauds phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias

If more than 1 cm of lengthening is required in a metatarsal, what procedure may be performed? How much lengthening is typically achieved with callus distraction?

Callus distraction with Mini-Rail fixation 1 mm per day (0.25 mm q6h) osteoblastic activity occurs both proximally and distally to the center of growth (will see cutting cone both directions)

What are the cardiovascular effects of NSAIDs?

Can cause vasoconstriction and increase blood pressure

What is the difference between Cataflam and Voltaren?

Cataflam is diclofenac potassium and has an immediate release Voltaren is diclofenac sodium and has a delayed release

What is the difference between cellulitis and erysipelas?

Cellulitis - confined deeper skin/subQ infection - staph aureus Erysipelas - more superficial infection that extends into the lymphatics - beta strep

a sore throat, with hoarseness and gray pseudomembrane would indicate?

Corynebacterium diptheriae - give the antitoxin

What drugs do NSAIDs interact with and what are the effects?

Coumadin - increases action of Coumadin Sulfonylureas - increases action of sulfonylureas Corticosteroids - increases GI risk Anti-epileptics - increases anti-epileptic toxicity Antihypertensives - antagonizes antihypertensive meds Digoxin - increases digoxin's effect Methotrexate - decreases methotrexate's clearance Lithium - decreases lithium's clearance Probenecid - increases concentration of NSADs

what IV solution has the highest osmolality? the lowest?

D50W 0.45% NaCl

what is the mechanism of talar dome i lesions?

DIAL a PIMP dorsiflexion inversion, anterolateral plantarflexion inversion, posteromedial.

what is a disorder characterized by multiple ossifications at tendinous insertions?

DISH - diffuse idiopathic skeletal hyperostosis

what is forrester's disease?

DISH - diffuse idiopathic skeletal hyperostosis

What is the Silfverskiöld test? how do you tell a positive test?

Determines gastroc vs. gastroc-soleus Positive test Dorsiflexion of the foot to neutral or beyond with the knee in flexion - Gastroc equinus Negative test Lack of dorsiflexion of the foot to neutral with knee in flexion and in extension - Gastroc-soleus equinus

what is diascopy, and what is it used for?

Diascopy Involves the application of or pressing of a flat transparent glass on the skin to blanch away redness Allows true color evaluation, as well as, helping to differentiate between purpura and vessel inflammation

Which NSAIDs have the least cardiovascular effects?

Diclofenac, ketoprofen

To correct a 5th digit adductovarus rotation, how should the skin incision be oriented?

Distal medial to proximal lateral

What are advantages of using a split-thickness skin graft? What are disadvantages? What are advantages of using a full-thickness skin graft? What are disadvantages?

Donor site heals spontaneously May cover large wounds Grafts are fragile Contraction of graft during healing May be abnormally pigmented Minimal contraction of graft Better appearance More difficult to take Must close donor site

name the antibiotics that aren't nephrotoxic?

Doxy and moxy take mino cleo to the zoo to see the tiger Doxycycline Moxycycline Minocycline Cleocin Zyvox linezolid Tigecycline

What is the treatment for Lyme disease?

Doxycycline 100 mg PO daily or Rocephin l g IV daily

what is the test for detection of gout in asymptomatic hyperuricemia?

Dual Energy CT (DECT) - an ultrasound scan

what procedure for the correction of cavus foot is a dorsiflexory osteotomy with fusion of the TN, and CC joints (MTJ).

Duvries

What is the triad of pulmonary embolism?

Dyspnea Chest pain Hemoptysis (although tachycardia is more common)

what muscles originate from the floor of the sinus tarsi/anterior process of the calcaneus?

EDB, and EHB

what muscle in the lower extremity has the largest excursion? what muscle in the lower extremity has the greatest strength?

EHL soleus

what are the manifestations of hypokalemia? what is the treatment?

EKG shows peaked P waves, and depressed T waves. (opposite of hyperkalemia) treat potassium deficit, and underlying cause.

what are the manifestations of hyperkalemia? what is the treatment?

EKG shows peaked T waves, depressed P waves (opposite of hypokalemia) fibrillations and death. increase cellular uptake of of K+ with insulin, or albuterol. increase K+ excretion with diuretic(loop, or thiazide) or kayexalate.

what is the next step after chest pain with negative cardiac enzymes?

EKG: if normal - stress test if abnormal - dobutamine stress test

what is the main screening exam for aids? what test is used to confirm the diagnosis?

ELISA western blot

what is the test for lyme's disease? what is the treatment?

ELISA and western blot to confirm doxycycline unless neurological symptoms are present - IV ceftriaxone

what is the diagnosis of cryoglobulinemia? how do you treat it?

ESR treat hepatitis, steroids if moderate, plasmapharesis if severe.

what are the diagnostic values for OM in ESR, CRP, an PCT?

ESR: >70. Normal below 20 CRP >14mg/L normal below 3 PCT(procalcitonin) >0.3ng/mL.

What nonpharmacologic measures are used for perioperative DVT prophylaxis?

Early ambulation - most important TEDs - thromboembolic deterrent stockings SCDs - sequential compression devices

What is the Thurston-Holland sign?

Epiphysis is separated from the physis with the fracture extending into the metaphysis resulting in a triangular fracture fragment (AKA Flag sign)

What causes the fibular deviation of digits in rheumatoid arthritis?

Erosive changes of medial plantar metatarsal heads compromises the integrity of medial collateral ligaments leading to lateral deviation of digits

Describe a Keck & Kelly procedure.

For Haglund deformity with cavus foot and high calcaneal inclination angle. Remove wedge from posterior-superior aspect of calcaneus. The posterior superior prominence is moved anteriorly.

What do you test clinically test via Jack Toe Test?

Foster fracture - a fracture of the entire posterior process of the tibia

how do you reverse warfarin in an emergent situation?

Fresh frozen plasma - works faster than vitamin K vitamin K takes 24-48 hours to fully work. FFP is immediate

what is the classification based on intra operative posterior tibial tendon appearances?

Funk type I - tendon avulsions type II - complete midsubstance rupture type III - in continuity tears type IV - tenosynovitis

what is the classification scheme for arch collapse?

GRACC - grand rapids arch collapse classification system. grade 1 structure affected: gastroc presenting pathology: equinus, plantar fasciitis, metatarsalgia Resulting biomechanics: weakened support. grade 2 structure affected: forefoot presenting pathology: HAV, hypermobile 1st ray, metatarsalgia, met stress fx. Resulting biomechanics: medial column incompetence. grade 3 structure affected: midfoot presenting pathology: arthritis of midfoot/TMTJ Resulting biomechanics: transverse arch collapse grade 4 structure affected: hindfoot presenting pathology: PTTD, hindfoot valgus, STJ arthritis, sinus tarsitis. Resulting biomechanics: medial arch collapse with spring ligament attenuation. grade 5 structure affected: ankle presenting pathology: valgus ankle arthritis Resulting biomechanics: deltoid ligament attenuation.

what radionuclide dye is useful for identifying neoplasms and inflammatory disorders and binds to WBC, plasma proteins and iron binding proteins?

Gallium 67 citrate

What are the types of corrosion in regards to implantable metals?

Galvanic - Occurs when two dissimilar metals are present in the same environment Fretting - Mechanical rubbing of one part on another which disrupts the passivation layer in an area of low oxygen resulting in localized corrosion Pitting - Localized corrosion in which pits form on the metal surface.

culture negative endocarditis is due to what?

HACEK organisms haemophilis parainfluenzae actinobacillus cardiobacterium eikinella kingella kingae

How does hyperbaric oxygen therapy assist wound closure?

HBOT increases the partial pressure of O2 in arterial circulation, which increases diffusion of O2 at the wound site. This is believed to increase growth factors promoting angiogenesis and collagen synthesis.

what radiographic view is best for visualizing the posterior and middle STJ coalitions? what radiographic view is best for visualizing the posterior and middle STJ facets?

Harris Beath Calcaneal Axial

how would you determine previous vaccination and immunity to hepatitis B?

HbsAb is vaccinated HbsAb and HbcAb is previous infection.

how would you determine a chronic infection of hepatitis B?

HbsAg positive

Talar torsion angle

Head is laterally rotated on the body Fetus 18-20° Childhood 30° Adult 40°

What are the minimum levels for hemoglobin and hematocrit for elective surgery?

Hemoglobin 10 gm/dL and Hct 30%

what is a neck osteotomy procedure used to corrects IM, PASA, and metatarsus elevatus?

Hohman - closing lateral wedge

How will wooden objects appear on US?

Hyperechoic with a hypoechoic dark shadow

Which NSAIDs are the most hepatotoxic?

Ibuprofen, naproxen, diclofenac

Which NSAIDs treat collagen vascular disease?

Ibuprofen, sulindac, tolmetin

a remote rash associated with a primary lesion caused by cutaneous sensitization to a distant allergic site.

Id reaction

When should a RBC transfusion be given? how much will a single unit of RBC increase the Hct?

If Hgb <8 or Hct<24, consider transfusing 1-2 units PRBC One unit of PRBC will increase Hct by approximately 3 percentage points

What is the perioperative management for patients with hypertension?

If the patient has been on long-term diuretics (e.g. HCTZ, Lasix), check for hypokalemia Avoid fluids high in sodium; may use 1⁄2NSS at low rate

How do you adjust the dose of a medication?

If the peak is too high, decrease the dose If the peak is too low, increase the dose If the trough is too high, increase the interval between doses If the trough is too low, decrease the interval between doses

When should a patient with an INR >1.4 be allowed to proceed to surgery?

If the risk of not doing surgery outweighs the risk of excessive bleeding If the patient has PVD and the surgery is a simple debridement or amputation.

how would you determine if a person is in recovery from an acute infection of hepatitis B?

IgG HbcAb and HbsAb positive

how would you determine an acute infection or highly infectious hepatitis B case?

IgM HbcAb and HbeAg infectious is eAg

what is the only ankle replacement that is approved for previously failed ankle replacement hardware?

Inbone or Inbone II long stem of modular intramedullary system Inbone II has a talar sulcus allowing more biomechanically stable articulations

Which NSAIDs are not renally cleared?

Indomethacin, sulindac

what is the jones tendon transfer? what are its indications?

a transfer of the EHL tendon from the distal phalanx to the head of the 1st metatarsal the EHL is attached to the EHB and arthrodesis of the IPJ is performed to prevent hammering indications are: pressure under 1st med head, or flexible cavus foot, flexible plantarflexed met head.

what radiographic view best visualizes all the STJ facets?

Isherwood 3 views

What is an advantage of using a muscle flap?

It brings immediate increased blood supply to donor site

Why does a total contact cast work?

It eliminates ankle joint motion and plantarflexion.

what is the single worst preoperative finding for cardiac risk?

JVD next would be MI within the last 6 months.

what procedure for the correction of cavus foot is a dorsiflexory wedge osteotomy across the tarsometatarsal joints?

Jahss

what procedure for the correction of cavus foot is a V osteotomy of the entire midfoot with the apex of the V proximal and highest point of the cavus.

Japas - V usually has its point at the navicular, and its arms extend out distally through the cuneiform and the cuboid

salmon colored rash on the chest and abdomen of a young woman with high spiking fever and high ferritin levels?

Juvenile inflammatory arthrtis/still's disease

what would you use to drill an osteochondral lesion of the talar dome?

K wire 0.062

what are the human mouth pathogens?

KACHE kingella kingae actinobacillus cardiobacterium hominis haemophilus Eikenella corrodens

what is a modified long arm shaft austin that does not correct PASA?

Kalish

What NSAIDS work on both the lipooxygenase and cyclooxygenase pathways?

Ketoprofen and diclofenac

What are effects of a long-term, high-dose course of steroids?

Long-term therapy suppresses adrenal function Risk of poor or delayed wound healing. Decreased inflammatory process. Risk of infection. Low WBC may mask infection.

what is the best modality for determination between a nonunion and a pseudoarthrosis?

MRI

What is the best study for evaluating avascular necrosis?

MRI - decreased signal intensity within medullary bone in both T1 and T2 images

What are characteristics of an osteochondroma?

Most common benign primary bone tumor Cartilage-capped, hyperplastic bone pointing away from the joint most often seen subungually in the foot. 2nd to 4th decades of life Suspect malignant transformation with growth after skeletal maturity, pain, or cap >2 cm

What are characteristics of a multiple myeloma?

Most common primary malignant bone tumor Punched out lesions or diffusely osteopenic with hair-on-end radiating spicules Affect 45-80 y/o Painful with weakness or neurologic symptoms Bence-Jones protein found within urine

What are characteristics of an osteosarcoma?

Most common primary malignant bone tumor most commonly sends mets to the lung. Sunburst periosteal reaction with Codman triangle and cloud-like, dense bone formation osteoid producing nature of the tumor yields elevated alk phos levels. 2nd to 3rd decades of life Dull aching pain

What are the sources of blood supply to tendons?

Myotendinous junction, paratenon, and at the insertion to bone

what is the treatment for acetaminophen overdose?

N-acetylcysteine charcoal can be given between doses.

acroosteolysis would be seen in what disorders?

NOT Acromegaly scleroderma hyperparathyroidism psoriatic arthritis

How does negative pressure wound therapy (e.g. Wound VAC) assist wound closure?

NPWT applies mechanical shear stress to the wound site. This is believed to promote granulation by decreasing bacterial bioburden, reducing edema, and inducing capillary budding.

what is the treatment of subacute thyroiditis?

NSAIDS, or steroids

what is the preferred initial treatment for juvenile rheumatoid arthritis?

NSAIDs

Do NSAIDs affect bone healing?

NSAIDs and COX-2 inhibitors may inhibit bone healing via their anti-inflammatory effects

when combining Tc and Ga bone scans, and the Ga and Tc are both positive what does that indicate? if the Ga is pos, and the Tc is neg? if the Ga is neg, and the Tc is pos?

OM - Ga indicates infx, Tc indicates bone involvement cellulitis - Ga indicates infx, Tc indicates no bone involvement. osteoarthritis, stress fracture, chronic OM - Ga indicates no infx, and Tc indicates no bone involvement.

When should a posterior malleolar fracture be fixated?

ORIF when fragment is greater than 25% of the posterior malleolus

What are normal values for PT/PTT/INR?

PT 11 - 15 sec INR 1 PTT 25 - 35 sec

what are the three sources of blood supply to the 5th metatarsal?

Nutrient artery Metaphyseal perforators Periosteal arteries

what is the posterior tibial tendon transfer? what are its indications?

PT tendon is transferred through the interosseous membrane and fixated to the 3rd cuneiform out of phase. indications are drop foot, and recurrent club foot

what tendon transfers could you perform for a recurrent clubfoot?

PT tendon transfer - out of phase TATT - in phase STATT - in phase

what is the treatment of thyroid storm?

PTU, iodine, steroids and beta blockers

What is the perioperative management for patients on long-term, high-dose steroids?

Peri-op IV steroid supplementation Hydrocortisone 100 mg IV given the night before surgery, immediately prior to surgery, and then q8h until postoperative stress relieved.

fiery and dusky red coloration of a leg that is present when in a dependent position, but disappears when elevated is called?

Peripheral arterial disease (PAD) - consult vascular

What tendons pass over the lateral ankle ligaments?

Peroneus brevis and longus

How are relaxed skin tension lines (RSTL) oriented?

Perpendicular to the long axis of the leg and foot

how would you treat someone who has a random plasma free metanephrine and normetanephrine test?

Pheochromocytoma: control the blood pressure alpha blocker after euvolemic add beta blocker perform surgery to remove tumor.

What are differences between phosphate and acetate-based steroids?

Phosphate-based - soluble with shorter half-life Minimize inflammatory reaction and edema Acetate-based - insoluble with longer half-life May delay inflammatory process or healing and can mask infection - do not inject into a joint

What are clinical findings of psoriatic arthritis?

Polyarthritis including DIPJ involvement Sausage digits Psoriatic skin changes Nail lesions pencil in cup deformity ivory phalanx

DOC for Necrotizing Fasciitis?

Primaxin (cilastatin/imipenem)

DOC for necrotizing fasciitis?

Primaxin 250-1000 IV q6-8h (most commonly 500 mg IV q8h)

what is the arthroscopic staging classification of OCDs?

Pritsch

cyma

Pronation - moves line anteriorly Supination - moves line posteriorly

what is the hallmark of infarction?

Q wave

how would you diagnose MI on EKG?

Q waves, new LBBB, or ST segment elevation in two or more limb or chest leads. T wave changes or ST segment depression.

what is the four drug regimen for tuberculosis?

RIPE rifampin, isoniazid, pyrazinamide, ethambutol

What are radiographic findings of gout?

Radiographic findings appear late in the disease after multiple attacks Bone lysis in acute stages Periarticular swelling with preserved joint space Tophi at joint margins Rat bite - punched-out, periarticular erosions Cloud sign - tophaceous material Martel sign - periarticular overhanging shelves of bone

How is Lovenox reversed?

Recombinant Factor VII

what type of screw has Proximal and distal threads separated by a smooth shaft. Proximal threads run clockwise, and distal threads run counterclockwise Does generate interfragmental compression.

Reese screw

What order do you resect and what order do you fixate the joints in a triple arthrodesis?

Resection 1. Midtarsal joints (T-N, CCJ) 2. Subtalar joint (T-C) Fixation (opposite order) 1. Subtalar joint 2. Midtarsal joints

what is the physiological cause of compartment syndrome?

Results when interstitial pressure exceeds capillary hydrostatic pressure, so the microcirculation shuts down.

What procedures correct PASA? What procedure corrects DASA? What procedure corrects hallux interphalangeous?

Reverdin Peabody Biangular Austin DRATO Offset V with rotation Proximal Akin Distal Akin

what metatarsal head osteotomy corrects PASA?

Reverdin (wedge) or reverdin green (L wedge) - protects sesamoids)

What is Felty syndrome?

Rheumatoid arthritis, splenomegaly, leukopenia

what tendon transfer would be useful for flexible rearfoot varus?

STATT procedure

would you give tPA to STEMI or NSTEMI? would you give heparin/LMWH to STEMI or NSTEMI?

STEMI - no benefit to NSTEMI NSTEMI

What are the two most common complications from a displaced, non-operative calcaneal fracture?

STJ arthritis anterior ankle impingement

What is the Valente procedure?

STJ block using a polyethylene plug with screw threads. Allows 4-5° of STJ pronation.

how is equinus compensated for in the foot? how is rigidly plantarflexed first ray compensated?

STJ pronation STJ supination pretty much everything else is STJ pronation.

how does the subtalar joint influence the midtarsal joint?

STJ pronation increases ROM at the MTJ and creates flexibility. STJ supination decreases ROM at the MTJ and creates rigidity.

during the contact period the posterior tibial muscle has a prime effect of decelerating which joint?

STJ subtalar joint

what is the most common complication of ankle arthrodesis in the elderly?

STJ subtalar joint arthritis - in every age population

What is the Sullivan sign?

Separation of digits caused by a mass within the interspace

What is a fabella?

Sesamoid bone occasionally found in tendon of lateral head of gastrocnemius

What are the different patterns of periosteal reactions?

Single layer - benign but sometimes malignant Onion skin - malignant, multiple layers of periosteum Sunburst - spiculated rays Hair on end - parallel rays Codman triangle - triangular elevation of periosteum

what type of EKG cardiac rhythm shows NSR with varying rate depending on respiration? increase or decrease with respiration?

Sinus arrythmia increasing with inspiration and decreasing with expiration.

What is the maximum length that a metatarsal may be acutely lengthened for correction of brachymetatarsia? what congenital disorders are associated with brachymetatarsia?

1 cm graft allows acceptable stretching of neurovascular structures turner's down's larsen's. NOT Kelly's

nerve fiber regeneration occurs at the rate of ______.

1 mm per day

what is an overuse injury in young athletes between ages 8-14 and results in pain and inflammation at the back of the heel?

calcaneal apophysitis gastroc contraction causes micromotion between the apophysis and the body of the calc. RICE, nsaids, heel lifts/cushions. can put in a CAM boot if the pain doesn't resolve over a couple weeks.

of the two joints in the midtarsal joint, which is most involved in stability?

calcaneocuboid joint

what bones are most often affected by tumors in the lower extremity?

calcaneus and metatarsals talus and phalanges being next.

what are the contraindications, limitations of bone stimulators?

can't be used for pseudoarthrosis if the gap is 1/2 the diameter of the bone. sepsis presence of neoplastic bone disease

what is the disadvantage to arthroscopic ankle fusion?

can't correct severe varus/valgus deformity contraindicated for correction of more than 15 deg.

what radiographic view is best for visualizing talar neck fractures?

canale view ap view but the foot is plantarflexed and pronated 15 deg.

what radiographic view is useful for talar fractures?

canale view foot plantarflexed, pronated 15 deg, and tube head 75 deg cephalad.

does a cortical or cancellous bone graft have many viable cells? does a cortical or cancellous bone graft have faster incorporation? does a cortical or cancellous bone graft revascularize? does a cortical or cancellous bone graft facilitate osteogenesis? does a cortical or cancellous bone graft allow creeping substitution? does a cortical or cancellous bone graft get completely replaced by new bone? does a cortical or cancellous bone graft have a haversian canal system?

cancellous does, cortical doesn't cancellous incorporates faster cancellous revascularizes cancellous does facilitate osteogenesis. both allow creeping substitution. cancellous gets completely replaced, cortical doesn't. cancellous does, cortical doesn't have haversian.

what type of bone growth stimulator has electrodes placed on the skin on either side of the fracture site?

capacitive coupling - noninvasive may cause irritation of the skin from the electrodes

what is phenol?

carbolic acid alcohol that is used after phenol is merely an irrigant

what are the metals inside a surgical instrument?

carbon - hardness chromium - prevents corrosion tungsten carbide - extreme hardness for teeth of needle drivers. nickel molybdenum

what is a cluster of furuncles that coalesce?

carbuncle

what are the natural absorbable sutures? what are the natural Non absorbable sutures? what are the synthetic absorbable braided sutures? what are the synthetic absorbable monofilament sutures? what are the synthetic non absorbable braided sutures? what are the synthetic non absorbable monofilament sutures?

cat gut, chromic gut Silk, steel Vicryl, Dexon, polysorb PDS (polydiaxonone), Maxon, Monocril. Nylon (both), dacron, ethibond, fiberwire prolene, surgilene, stainless steel, ethilon, goretex

what is a complication of anesthesia that results in "saddle anesthesia", which has loss of sensation to the groin and inner thighs, bladder or bowel incontinence/dysfunction, absent achilles reflexes and lower extremity weakness, back pain, and sexual dysfunction?

cauda equina syndrome could also be a history of malignancy with chemo, and now has bladder incontinence. decreased anal sphincter tone.

what are the cephalosporins that are safe for PCN allergy?

cefuroxime, cefdinir/omnicef

What is the only FDA-approved COX-2 inhibitor?

celecoxib (Celebrex)

what are the three phases of host biologic response to an implanted biomaterial?

cellular response tissue remodeling infection potential

what portion of the navicular is most avascular? what arteries supply the navicular?

central 1/3rd DP supplies the dorsal and medial aspects medial plantar supplies the plantar and lateral

normal bone circulation is centripetal/centrifugal? what can change the normal bone circulation to the reverse?

centripetal changes to centrifugal by reaming for IM nail

what are the anaerobe antibiotics?

cephalosporins aminoglycosides clindamycin flagyl carbapenems

what procedure performed for frontal plane flatfoot deformity is an osteotomy that raises the posterior facet of the STJ on the calcaneus and uses a bone graft?

chambers

what is the genetic change that occurs in sickle cell?

change in amino acid 6 from glu to val results in hemoglobin S

what are the manifestations of hypernatremia? what is the treatment?

change in mental status, weakness, irritability, focal neural deficits, coma. replace water loss

what is the most common hereditary neuromuscular disorder?

charcot marie tooth disease

what are the joint sparing hallux rigidus/limitus procedures? what are the joint destructive hallux rigidus/limitus procedures?

cheilectomy cartiva keller hemi implant total implant valenti

what are the most common adverse events associated with the administration of vitamin K for reversal of anticoagulation?

chest tightness and dyspnea

what is a recurrent localized inflammation of small blood vessels resulting from the cold?

chilblains/pernio

What can cause Gray Baby Syndrome?

chloramphenicol - antimicrobial/antifungal

on radiograph you see a Benign, geographic, osteolytic, lesion with sclerotic margins and stippled calcifications. may see hemorrhagic foci, and cystic blood spaces.

chondroblastoma can mimic aneurysmal bone cyst. symptoms of pain and swelling/tenderness

radiographic appearance of eccentrically located radiolucent lesion that is lobulated/bubbly with sclerotic, well developed margins. progressively becoming painful.

chondromyxoid fibroma

Common, malignant, moth-eaten, lesion with medullary and soft tissue calcifications?

chondrosarcoma - the key diagnostic sign is the so-called "smoke ring calcification" within the tumor

what is the most common complication in surgical repair of all forms of polydactyly?

choosing the wrong toe for amputation

at what level of amputation does tendinous transfer required?

chopart amputation - tib anterior is reattached to the neck of the talus to prevent equinovarus

what are the metals found in a stainless steel screw?

chromium, nickel, molybdenum

an infection that presents by way of a puncture wound that that is mostly in the tropics and can form a warty, tumor like lesion?

chromomycosis

what type of leukemia has the philadelphia chromosome?

chronic myeloid leukemia (CML) - t9,22 also bcr-abl gene

what are the indications for a TENS unit?

chronic pain muscle atrophy muscle spasms/fatigue edema peripheral neuropathy

what type of specific synovitis occurs in three stages?

chronic synovial chondromatosis

atrophie blanche, which is small ivory white plaques and depressed plaques with stippled discoloration is most closely associated with?

chronic venous stasis ulcerations and insufficiency. also called livedo reticularis

what is pletal? what is trental? what are they used for?

cilostazol, and pentoxifylline intermittent claudication

what is the incision that involves the posterior, medial and lateral aspects of the foot and ankle?

cincinnati incision - do not perform in patients older than 4. for clubfoot release.

what are the oral pseudomonas antibiotics? what are the IV pseudomonas antibiotics?

ciprofloxacin cephatazodime cefepime/maxipime aztreonam zosyn timentin aminoglycosides

what are the two classifications of melanomas? how do you classify each? which has treatment parameters in the classification?

clarks (depth of invasion) stage I - epiderims stage II - papillary dermis stage III - junction of papillary and reticular dermis stage IV - reticular dermis stage V - subQ fat breslows (thickness of tumor) ,0.75mm - 97% survival at 10 yrs 0.76-1.5mm - 87% 1.51-3.99 - 67% >4.00 - 40% breslow has treatment parameters 1mm or less - 1cm normal margins 1-2mm 1-2cm of normal margins 2mm or more - 2cm normal margins.

what is the most common cause of C. diff? how do you treat it?

clinda Vanco 125 mg PO q6h Flagyl 500 mg PO TID

what are the IV alternatives for PCN allergy patients? what is the DOC for diabetic with PCN allergy?

clindamycin, vancomycin, levaquin, bactrim clinda

what is the treatment for congenital vertical talus/convex pes planovalgus/rocker bottom flatfoot in a child less than 3 months? for 3 mo to 3 years? 3-6 years? older than 6 yrs?

closed reduction with manipulation and casting - rarely affective open reduction can be performed at 3 months, posterior release and reduction of TN joint. open reduction with, extra articular arthrodesis (green grice - trephine plug into the sinus tarsi) or arthroereisis. postpone surgery until skeletal maturity (10-14) when triple arthrodesis is performed.

most likely organism in an infection with association of the dirt or soil?

clostridium

what is the most likely pathogen in dirt/soil?

clostridium

most metal joint implants are made of? what material encourages osseous integration?

cobalt chromium - due to high strength and smooth polished finish. titanium

What is the only local anesthetic that causes vasoconstriction? how does it produce vasoconstriction?

cocaine it constricts blood vessels by potentiating the action of norepinephrine, thereby preventing its own absorption through vasoconstriction.

a systemic infection usually from inhalation that is more common in dark skinned people and can produce cough, malaise, fever.

coccidioidomycosis

what is a surgical procedure to deal with AVN caused by steroids?

code decompression

what is the makeup of tylenol #3?

codeine/acetaminophen (30 mg/300 mg)

what is the primary test for determining whether a cavus foot is forefoot/rearfoot and flexible/rigid?

coleman block test - place the person's lateral forefoot (3-5 rays) on a block with the 1st ray purchasing the ground, if the varus rearfoot corrects its a flexible deformity, if it does not its rigid.

what type of wound care dressing provides scaffold for granulation and epithelialization?

collagen dressing - fibracol, promogran, Nu-Gel, Oasis

what is the distal end of the power saw where the blade attaches?

collet

what type of atrophic non union has the presence of one or more necrotic intermediate fragments?

comminuted

with regards to bone growth and bone stimulators, the compression side of a bone has positive/negative potentials? This stimulates osteoblasts/clasts? The tension side of a bone has positive/negative potentials? This stimulates osteoblasts/clasts?

compression has negative potentials which stimulates osteoblasts which results in bone formation. tension side has positive potentials which stimulates osteoclasts and bone resorption it all works by the piezoelectric principle.

what is the mechanism of peroneus brevis longitudinal tears?

compression into the peroneal tubercle/fibular ridge by the peroneus longus

what is the radiographic effect that occurs when an xray photon interacts with an outer shell electron? at what kVp does this effect happen at? it causes more/less radiation? it is good/bad for the image?

compton effect 80 kVp less radiation bad for the image quality

what area the four ways heat can be applied to the body, and what are examples of those?

conduction is transfer of energy from a hot surface to a cold one - paraffin wax and moist heat packs convection is transfer of heat from movement over the body - whirlpool/hydrotherapy conversion is converting one energy to another - ultrasound uses sound to create heat radiation - through UV waves

What is another name for vertical talus?

congenital convex pes valgus

oligohydramnios is linked to what pediatric congenital abnormality?

congenital talipes equinovarus

a pericardial knock during auscultation would point towards? how do you treat it?

constrictive pericarditis - fibrotic changes in the pericardium pericardiectomy

what is the classification scheme for MRI grading of posterior tibial tendon tears?

conti MRI class stage I - tenosynovitis, bulbous appearance with *vertical splits* stage II - partially torn, attenuated with *longitudinal splits* stage III - complete rupture with tendon gap

continuous or pulsed ultrasound waves provide thermal and mechanical effects?

continuous pulsed provides only mechanical stimulus

what is the most common or more likely sequelae of compartment syndrome?

contracture of the toes

would you place a plate on the concave or convex side of a fracture?

convex placing it on the concave side will lead to gapping because the most force is on the convex side

when doing an MRI for tarsal coalition, what plane is best for TC coalitions? for CN bar?

coronal plane sagittal plane

what are the relative radiographic densities of tissues from highest to lowest densities?

cortex, cancellous, muscle, nerve, tendon, ligament, subQ, fat, air

a cortical bone graft is radiolucent/radiodense when healing? cancellous?

cortical is radiolucent cancellous is radiodense

when is a cortical bone graft weakest? when is a cancellous bone graft weakest?

cortical is weakest at 8 weeks cancellous becomes stronger each week

what procedure performed for sagittal plane flatfoot is an opening dorsal wedge of the 1st cuneiform?

cotton

what is the classification for tailor's bunions?

coughlin o Type I Lateral metatarsal head prominence/enlarging o Type II "Bowing" of 5th metatarsal o Type III Increased IMA of 4th and 5th (>8*) o Type IV (not described by coughlin) Combination

what is the classification system for hallux rigidus/limitus?

coughlin and shurnas grade I no DJD, pain at end ROM, hyperextension of IPJ, ROM WNL. grade II pain at end ROM, flattening of the met head, passive ROM limited, dorsal exostosis grade III DJD and osteophytes, crepitus on ROM, pain on full ROM grade IV obliteration of joint space, less than 10 deg of ROM

what is the process by which most cellular elements of the graft die and are replaced by viable bone?

creeping substitution

what are the base osteotomy procedures? which can correct PASA?

crescentic - does not shorten the met trethowan - opening base wedge Juvara - closing oblique base wedge Loison-Blacescu - lateral closing base wedge Logroscino - reverdin plus lateral closing base wedge - corrects IM and PASA

what base procedure for HAV has the highest dorsal malunion rate?

crescentic osteotomy

the posterior musculature that is divided into deep and superficial is separated by what?

crural fascia

a systemic infection usually from inhalation that has a predilection for brain and meninges, most commonly found in bird manure, pigeon.

cryptococcus neoformans

what disorder is due to excess cortisol production or exogenous ingestion of glucocorticoids?

cushings

when performing a tendon lengthening procedure, how much of the tendon do you cut, and which directions are the cuts?

cuts are made through 51% of the tendon two cuts medial, one lateral

a sterile intradermal mass of fluid or other material, contained within a defined wall. an intra epidermal tunnel formed by an insect/parasite.

cyst burrow

what are the common symptoms of hyperthyroidism? what are the common symptoms of hypothyroidism?

excess sweating, excessive hunger, fatigue, heat intolerance, or restlessness, mood swings, nervousness, or panic attack, abnormal heart rhythm, or palpitations, insomnia, hyperactivity or irritability, weight loss, diarrhea. brittle nails, constipation, dry skin, high cholesterol, irritability, sensitivity to cold, sexual dysfunction, slow heart rate, sluggishness, weight gain

what is the treatment of choice for a giant cell tumor of a tendon sheath?

excision

what are the two possible stress tests?

exercise stress test - positive when there is a >2mm STJ segment depression or a drop of >10mm of systolic BP dobutamine or dipyridamole stress test - same positive criteria

clostridium tetani releases an endotoxin/exotoxin that causes a pre or post sympathetic/parasympathetic blockade?

exotoxin and presympathetic blockade

what are the benefits of meshing a split thickness skin graft?

expands covering more surface area allows drainage of hematoma/seroma increases surface area for reepithelialization

what is the best form of fixation in the area of frank infection?

external fixator

what is the main purpose of the SACH heel modification in shoes?

extrinsic shock absorbtion

neuropraxia results in what functions lost, and which maintained?

deep tendon reflexes, skeletal muscle function, vibratory, two point discrimiation lost. pain, temp, autonomic func. maintained. repair is days to months.

venous insufficiency/stasis is a result of? what is the cause of stasis dermatitis?

deep venous thrombophlebitis, which results in destruction of valves, and loss of normal superficial to deep venous flow. hemosiderin deposits are caused by venous hypertension and distended local capillaries which leeches RBCs into the tissues.

when attempting to get wound cultures the ideal situation is?

deep wound specimen of tissue (not a swab) following incision and drainage with pulse lavage before beginning antibiotic therapy.

what type of atrophic non union has gapping at the fracture site due to a loss of a fragment?

defect

what is the antidote for iron overdose?

deferoxamine

a patient just out of general anesthesia is violently shaking as if cold, what med will relieve the symptoms?

demerol

dimple sign (lateral compression of the lesion yields a depression or dimple) is associated with?

dermatofibroma - button like dermal fibroma usually no treatment unless causing pain or cosmetically problematic

a hard elevated papule with darkened uniform color that is benign would likely be?

dermatofibroma - dimple sign positive.

what disorder would have the classic heliotrope/violaceous inflammatory changes of the eyelids and periorbital area?

dermatomyositis/polymyositis

what disorder is diagnosed with a positive anti Jo? anti ds DNA? anti Smith? anti RNP? anticentromere? anti Scl 70? anti Ro? anti La? anti histone? anti microsomal anti transglutaminase anti desmoglein

dermatomyositis/polymyositis lupus/ SLE - lupus nephritis lupus/SLE - most specific for disease Mixed connective tissue disease (MCTD) CREST syndrome(limited scleroderma) diffuse scleroderma sjogren syndrome - against parotid glands sjogren syndrome - more specific drug induced SLE/lupus hashimoto's celiac disease pemphigus vulgaris

gottron sign would be associated with what?

dermatomyositis/polymyositis - inflammatory disease of skeletal muscle characterized by proximal, symmetrical muscle weakness, and if associated with skin lesions called dermatomyositis. gottron sign - flat topped violaceous papules over the knuckles.

microscopic examination of an organism reveals a spaghetti and meatballs appearance. what are you looking at?

dermatophytoses - tinea KOH prep will show these organisms

what is the tissue in the ankle joint that is debrided during a scope?

detritic synovitis - Foreign body reaction to shards of silicone materials in the lymphatic system

what is a medial longitudinal incision with limited exposure?

devries incision

what is the most accurate test for osteoporosis? what level is osteopenia diagnosed at? what level is osteoporosis diagnosed at?

dexa scan 1.0 -2.5 SD below normal adult

what is the best test for cushings?

dexamethasone suppression test if ACTH is suppressed - pituitary adenoma if ACTH is not suppressed its ectopic an ectopic cause. and would perform the plasma ACTH if ACTH is high - ectopic ACTH production - CT chest, MRI brain. (adenoma) if ACTH is low - adrenal gland - CT abdomen.

what conditions are often associated with charcot?

diabetes alcoholism syringomelia

best NSAID for asthmatic?

diclofenac

what procedure is a proximal akin with fixation to the 4th metatarsal with pins/kwires?

diebold and bejjani

what are the biomechanical compensations for a sagittal plane cavus deformity?

digital contraction MPJ retrograde buckling lesser tarsal sagittal plane flexibility pseudoequinus

what medication decreases the rate of hospitalization in patients with CHF?

digoxin

patient presents with nausea, vomiting, blurred vision with yellowing of the vision, and cardiac arrhythmias. what is the drug overdose? how do you treat it?

digoxin DOC is digoxin specific antibodies/digitalis Fab fragments/digoxin immune fab. correct arrhythmias with lidocaine correct electrolyte abnormalities dialysis

what are the two signs when looking at if the fibula is out to length after ankle fracture?

dime sign - unbroken curve between the lateral talus and the peroneal groove of the fibula. shenton line - small spike or fibular tubercle should be in line with the tibial plafond/subchondral bone.

what is the best protection against occupational radiation exposure?

distance then shielding

the strongest half pin configuration for external fixator is?

divergent then convergent then parallel

describe the vascular supply of the talus?

dorsalis pedis - Supplies the superior aspect of the head and neck - Anastomoses with the peroneal and perforating peroneal arteries Artery to the sinus tarsi - supplies the lateral aspect of the talar body - Forms an anastomotic sling with the artery of the tarsal canal Posterior Tibial Artery gives off the Deltoid branch - supplies the medial aspect of the talar body Artery of the canalis tarsi: majority of the talar body -Forms an anastomotic sling with the artery of the tarsal sinus Peroneal/Perforating Peroneal Artery - supplies posterior and lateral aspects of the talar body - Anastomoses with the dorsalis pedis artery branches

what is the open kinetic chain pronation at the subtalar joint? what is the closed kinetic chain pronation at the subtalar joint?

dorsiflexion, eversion, abduction (STJ is open DEB) plantarflexion, eversion, adduction (STJ PED is closed)

what is the sign seen on ultrasound for diagnosing gout?

double contour sign

what is the classification system for tarsal coalitions?

downey juvenile/adult: I - extra articular IA - no arthritis - bagley (juvenile), resection or triple IB - arthritis - isolated, or triple fusion II - intra articular IIA - no arthritis - resection, isolated fusion, triple IIB - arthritis - isolated or triple fusion

what antibiotics have the best bone penetration for osteomyelitis?

doxycycline and ciprofloxacin

what is the drug of choice for lyme's disease?

doxycycline or rocephin/ceftriaxone

what is the difference between wet and dry gangrene?

dry gangrene is a slow stoppage of blood flow and is not usually a source of infection/infected. wet gangrene is due to sudden occlusion and usually is bacterially infected.

what are the two types of muscular dystrophies with progressive proximal weakness and pseudohypertrophy?

duchennes - dead by 20 - sex linked recessive becker's - dead by 40 - sex linked recessive

What are the only FDA-approved drugs for treating diabetic neuropathy?

duloxetine/cymbalta pregabalin/lyrica

what are some procedures for peroneal tendon dislocation/subluxation repair?

duvries - sliding osteotomy of the distal fibula kelly - distal fibular osteotomy with rotation and displacement. jones - strip of achilles recreates the peroneal retinaculum groove deepening - osteotomies or just drilling.

what procedure for the correction of cavus foot is a lateral closing base wedge of the calcaneus?

dwyer - just distal to the calcaneal apophysis

what type of plate has wider and deeper holes that allow for eccentric drilling and axial compression? what type of plate protects against shear, bending, and torsional forces. all holes are drilled centrally, compression obtained through lag screws? what type of plate maintains alignment of unstable fracture fragments by pushing them together, used to maintain separation, and to protect grafts/bone from crush? no compression.

dynamic compression plate neutralization plate buttress plate - must be bent to match the contour of bone to truly provide buttressing.

any disorder of eccrine sweat ducts.

dyshidrosis

what type of gait has a high degree of variability and is characterized by motion involving considerable effort, with deliberated and concentrated steps. what is it seen in?

dyskinetic gait CP, huntington's chorea, dystonia, muscular deformities

what is the process by which natural absorbable sutures are broken down? what is the process by which synthetic absorbable sutures are broken down? which results in more soft tissue reaction?

enzymatic degradation hydrolysis - mild soft tissue reaction compared to enzymatic.

Common cyst that occurs in the skin secondary to traumatic implantation of the epidermis into the dermis. A sinus tract may develop exuding a pasty, foul-smelling, cheese-like material.

epidermal inclusion cyst/ epidermoid cyst surgical excision

a split thickness skin graft autograft has what layers of skin? a full thickness skin graft?

epidermis and varying amounts of dermis epidermis and all the dermis

between a spinal block and an epidural block, which will give you better control?

epidural block

what is the most important structure in the tendon repair process?

epitenon

what is the outer covering of a tendon within its sheath?

epitenon

infectious mononucleosis is caused by? how do you treat it?

epstein barr virus - kissing virus give steroids - do not give antibiotics as it will cause a rash

the most common foot and ankle deformity encountered in polio is?

equinus

tender, red, raised nodules on the shins with a smooth and shiny appearance seen in young women taking oral contraceptives would be?

erythema nodosum - seen in sarcoidosis treat with NSAIDs, but is self limiting.

sudden onset of painless upper GI bleeding hematemesis or melena. how would you treat it?

esophageal varices IV octreotide and ciprofloxacin then endoscopy with sclerotherapy.

an infection that presents by way of a puncture wound that has a classic triad of swollen lesions, draining sinuses, and grains of colonies draining from the sinuses.

eumycotic mycetoma/madura foot

what procedure addresses the midtarsal locking mechanism?

evans procedure

a plantar fasciitis case would have what appearance on diagnostic ultrasound?

fascia that measures greater than 4mm and has decreased echogenicity indicative of inflammation

EMG that shows denervation would show what?

fasciculations at rest with movement the number of motor units under voluntary control is decr. duration and amplitude of individual potentials is increased.

what are the diagnostic values for type II diabetes?

fasting glucose - >126mg/dl random/non fasting glucose >200mg/dl A1c >6.5

what is the most common predisposing factor to hallux abducto valgus?

female gender - 92% family history - 83% long first metatarsal - 71% oval/round first met head - 71%

polydactyly is more common in males/females? syndactyly is more common in males/females? macrodactyly is more common in males/females? brachymetatarsia is more common in males/females?

females males males - neurofibromatosis assoc. females - 1st or 4th most common

what type of gait does parkinson's have?

fenestrating gait

what type of gait has shuffling with loss of reciprocal arm swing and increased step rate.

fenestrating gait

what laboratory/vital signs are poor indicators in diabetics?

fever and leukocytosis diabetics don't mount fever or leukocytosis so don't look for it.

in a thyroid nodule with normal thyroid function tests, what is the next best step?

fine needle aspiration biopsy

what type of EKG cardiac rhythm shows prolongation of the PR interval?

first degree heart block

what is the treatment of hyperthyroidism?

first start a beta blocker, and then start a thionamide (PTU or methimazole) if pregnant PTU is the DOC. after disease is controlled ablation of the thyroid may be performed.

syndactylization is useful for what disorders? what is the depth of dissection of the skin for the procedure? what is a potential cause of failure of the procedure?

flail toe heloma molle dissection and fusion is to the dermis only the deforming forces of the flail toe/heloma molle must be eliminated prior to syndactylization, and the adjacent toe must be stable and rectus.

what sign is pathognomonic for lisfranc injury? what sign is pathognomonic for calc fracture?

fleck sign - 1st interspace avulsion mondor sign - plantar foot ecchymosis

what deformity is steindler stripping performed for?

flexible cavus

what are the indications for subtalar arthroereisis? what are some complications? what are the contraindications to its use?

flexible pes planus PTTD migration, lateral foot pain, synovitis, sinus tarsi pain, talar neck fracture. valgus ankle, metatarsus adductus, angular leg or knee deformities

what is the normal knee flexion/extension?

flexion - 130-150 extension 5-10 past vertical

calcaneal heel spurs occur at the insertion point of the?

flexor digitorum brevis muscle NOT the plantar fascia

the sesamoids act as a pulley to optimize the pull of which muscle in stabilizing the hallux against the ground.

flexor hallucis brevis

the central compartment communicates to the distal deep leg and vice versa via the?

flexor hallucis longus tendon flexor digitorum longus tendon

what are the borders of the tarsal tunnel?

flexor retinaculum - medial/post. calcaneus and posterior aspect of the talus - lateral distal tibia and medial mal - anterior

how would you diagnose diverticulitis? diverticulosis?

abdominal and pelvic CT colonoscopy

a painless pulsatile mass in the abdomen can be diagnosed as?

abdominal aneurysm ultrasound is best for diagnosis

what muscles are innervated by the lateral plantar nerve?

abductor digiti minimi quadratus plantae 2nd-4th lumbrical

what is the normal medial clear space of the ankle? normal tib fib overlap? normal talar tilt? what is the normal tib fib clear space?

about 5mm (4-6mm) about 10 mm 10 deg. 6mm

a diffuse velvety thickening and hyperpigmentation of the skin that may precede other symptoms of malignancy by 5 years.

acanthosis nigricans usually in the axillae and on the neck.

a diffuse velvety thickening and hyperpigmentation found in the axilla and on the neck would possibly indicate?

acanthosis nigricans - which may precede other symptoms of malignancy by 5 years. can also indicate insulin resistance.

for a patient with dysphagia for liquids and solids the first line diagnostic test is barium swallow. if it shows bird's beak appearance, what would that indicate? if it shows corkscrew esophagus what would that indicate?

achalasia diffuse esophageal spasm

what is a tendon transfer that can be performed to help realign the sesamoid apparatus during a bunionectomy repair?

adductor tendon transfer

how would you diagnose MEN I? how would you diagnose MEN II?

adenomas in two of the three P's: pituitary, parathyroid, pancreatic/gastric. medullary thyroid cancer pheochromocytoma hyperparathyroidism (check RET oncogene) - plus parathyroid - MEN2A - plus ganglioneuroma - MEN2B

what is a procedure that can be performed for a spastic equinus?

advancing the insertion of the achilles anteriorly on the calcaneus, the muscles lose some mechanical advantage and decrease the equinus. transfer to just posterior to the posterior facet of the STJ, weakens the triceps surae by 50%, but weakens toe off by only 15%

what can improve benign essential tremors? what is the drug of choice?

alcohol propranolol hand tremor, less at rest with head bobbing.

Unasyn what is the dose? what is the indication? what is the spectrum of activity? does it cover pseudomonas?

ampicillin/sulbactam 3.0 g IV q6h empiric therapy for polymicrobial diabetic foot infections staph, strep, enterococci, gram negs, anaerobes. no

what is a degenerative disease of both UMN and LMN? how is the diagnosis made?

amyotrophic lateral sclerosis/ALS/Lou Gehrig's disease. cognition remains intact. diagnose with electromyogram

what is an OCD? what does it stand for?

an area of necrosis/compression leading to necrosis beneath the cartilage of the bone. - usually the talar dome. osteochondral defect

what is the other name for a T1 weighted MRI? for a T2 weighted MRI?

anatomic view pathologic view

what is the antibiotic of choice for a gustillo - Anderson type I? type II? type III?

ancef ancef, clindamycin ancef, clindamycin, aminoglycoside.

How to treat serious hospital acquired Gram negative infections?

ancef, gentamycin/aminoglycosides

on xray of the spine you see obliteration of the intervertebral discs also called "bamboo spine", what is indicated?

ankylosing spondylitis - NSAIDs and physical activity bamboo spine is late radiographic finding sacroilitis is early radiographic finding

which muscles in the lower extremity are active in both stance and swing phase?

anterior compartment leg muscles

what radiographic view is best for visualizing ATFL injuries? CFL injuries how would you determine if its a positive test?

anterior drawer - pos if more than 6 mm of gap between the posterior tibia and the talar dome. stress inversion/talar tilt - pos if more than 5 deg compared toe the contralateral side.

what is a neutralization plate placed on the posterior aspect of the fibula or tibia?

anti glide plate apparently only needs one screw since its placement and structure is what prevents the posterior glide.

a person that has an increased risk of recurrent spontaneous abortion and clots (DVT/PE) would have? how is it diagnosed?

anti phospholipid syndrome (cardiolipin and lupus anticoagulant) russell viper venom test - for lupus anticoagulant consider lifelong warfarin

what drugs can cause torsades de pointes?

antiarrhythmics antipsychotics TCAs fluoroquinolones IV magnesium sulfate

what is the magic angle effect?

any MRI taken at 55 deg. to the course of the peroneal tendons will show a false positive damage.

what score is used to determine perinatal asphyxia

apgar appearance, pulse, grimace, activity, respiratory effort 0-10 normal is 8-10

what type of anemia has pencytopenia due to bone marrow failure, and bone marrow will be fatty and hypocellular?

aplastic anemia

what wound care product is a living bilayered skin substitute? what wound care product is only the dermal component of skin?

apligraf dermagraft

what is the principle of load screw technique?

application of a plate with drill holes eccentrically away from the fracture line.

what wound care dressings decrease the bio burden, but is not a substitute for antibiotic therapy?

aquacel, actisorb, iodojilex, silvasorb

rest pain would be a symptom of arterial or venous insufficiency? how would you resolve the pain?

arterial insufficiency elevation increases it, hanging the foot off the bed relieves it.

if a patient has an OCD that is more than 3cm, and is over 50 yrs what would you use to treat it?

arthrodesis

if a patient has an OCD that is less than 1.5cm, and is under 50 yrs what would you use to treat it?

arthroscopy, drilling, curettage.

what fungal infection causes pulmonary infection causing mycetoma, and will show a halo sign on CT. mostly in immunocompromised patients. what is the treatment?

aspergillosis - fungal ball (mycetoma) for mild - steroid taper for mycetoma - surgical resection for invasive aspergillosis - voriconazole, or amphotericin B

What causes irreversible inhibition of the platelet cyclooxygenase aggregation?

aspirin all other NSAIDs are reversible inhibition.

non unions are classified as atrophic and hypertrophic, what are the classifications of each? which requires surgical excision and bone grafting? what is the classification scheme?

atrophic: torsion wedge, comminuted (necrotic butterfly frag), defect, and atrophic - requires surgical excision and bone graft. hypertrophic: elephant foot (maximal widening), horse hoof (moderate flaring), oligotrophic (minimal reactive callus) - non surgical (immobilization and bone stim) - 90% of the time weber and cech

what is the antidote for organophosphates overdose?

atropine, pralidoxime

DOC for dog and cat bites? DOC for human bites?

augmentin - pasturella multocida augmentin - eikinella corrodens

what PO antibiotics are considered the best for OM? for IV?

augmentin 875/125 clinda plus cipro moxifloxacin zosyn unasyn tigacycline if MRSA is suspected add vanco

what is the most common type of 5th metatarsal fracture?

avulsion fx of the 5th met styloid process - 51% transverse shaft fx - 17% true jones fx - 14% dancer's fx - 11%

what is the classification system for metatarsus adductus?

bleck classification Normal - bisection between the heel extends distally to the 2nd toe mild - extends to the 3rd toe moderate - extends to the 3-4th interspace/toe severe - extends to the 4-5th interspace/toe

what type of AVN/osteochondrosis is of the proximal medial epiphysis of the tibia? of the 2nd metatarsal head of the navicular? of the femoral head? of the tibial tuberosity? of the calcaneal apophysis?

blount disease freiberg (2>3>4>5) Kohler disease - self limiting (silver dollar/coin sign on radiographs) legg-calve-perthes disease - most common type of AVN/osteochondrosis osgood-schlatter - self limiting sever disease -heel lifts - seen in equinus

what is the cause of a blue toe post operative? what are the steps to resolve it?

blue toe - venous in order of first to last loosen bandage twist K wire remove K wire reopen the wound

what kind of needle is used for friable tissue? for calcified tissue? for tendon? for subcutaneous tissue and fascia? for skin?

blunt point taper cutting taper cutting taper point reverse cutting or conventional cutting

what are the two radiographic views of critical importance in evaluating calcaneal fractures?

bohler's angle - 25-40 deg - decreases with fracture gissane's angle - 124-140 deg - increased with fracture both demonstrate lack of calcaneal height

what tissues are the most sensitive to radiation in the body?

bone marrow > GI > Central nervous system According to bergonie and tribondeau

what is the definition of osteomalacia?

bone produced is architecturally abnormal and the osteoid is non mineralized

What study can distinguish between a hypertrophic and an atrophic non-union?

bone scan - positive for a hypertrophic and negative for an atrophic (avascular) non-union CT scan

what modality can allow for early diagnosis of stress fractures? how soon after injury?

bone scans (scintigraphy) - as early as 7 hours post injury bone scans identify areas of high bone turnover or osteoblastic activity

what differentiates hallux rigidus from limitus

bony ankylosis and sesamoid immobilization

what are the deformities seen in rheumatoid arthritis? what are the aspects of each?

boutonniere deformity - flexion of PIPJ, and hyperextension of the DIPJ. swan neck deformity - hyperextension of the PIPJ, and flexion of the DIPJ baker's cyst - synovial filled cyst which develops in the popliteal fossa. the joint nodes affect the PIPJ, but not the DIPJ. unlike OA which affects both.

In situ squamous cell carcinoma that presents at the junction of skin and a mucocutaneous region that resembles a localized patch of psoriasis/tinea/dermatitis?

bowen's disease

what type of plate is used to maintain length during healing without disrupting the damaged portion of bone by bypassing the area of comminution?

bridge plate screws are placed only in the most proximal and distal segments.

what radiographic view is useful in comminuted fractures of the calcaneus to visualize the middle and posterior facets?

broden I view

what radiographic view is useful in visualizing depressions in the posterior facet of the STJ?

broden II view

what are the radiographic views used to visualize the middle and posterior facets of the calcaneus? what are the radiographic views to visualize all of the calcaneal facets?

broden's view isherwood views

what is a chronic radiolucent cavity/cyst in the metaphysis of a long bone surrounded by dense sclerotic bone? what does it signify?

brodie's abscess subacute OM

what are the anatomic classification systems of charcot?

brodsky and Schon or sanders and Freykberg I - IPJ, phalanx, MPJ, metatarsals II - lisfranc III - CN, TN and CC IV - ankle V - calcaneus

what procedure is a repair of the lateral ankle ligaments? what method is utilized in the repair?

brostrum - repaired by imbrication/overlapping of the retinaculum and ligaments and suturing in a "pants over vest" fashion.

a blistering of the skin that are tense and pruritic.

bullous pemphigoid - no basement membrane involvement

what are the three primary stitches used in repairing an achilles tendon?

bunnell - figure 8 or weave krakow - interlocking stitch kessler - box

AVN/osteochondrosis of the cuneiforms talar body? phalanges? 5th met base? distal tibia? fibular head? fibular sesamoid? tibial sesamoid? cuboid? 1st metatarsal head?

buschke diaz/mouchet thiemann iselin lewin ritter treve renandier lance assmann

what is the pain medication with the least amount of respiratory depression?

butorphanol/stadol

what are the three etiologies of hammertoes? what muscles are overpowered? what muscles compensate?

flexor stabilization *most common* - long flexors overpower the interossei flexor substitution - weak triceps surae results in deep posterior and lateral leg compensation. this causes a high arch foot and and contracted digits. extensor substitution - long extensors overpower the lumbricals.

what are the best donor sites for full thickness skin grafts? donor sites are closed by? length to width ratio of donor site should be?

flexor surfaces especially the groin (pinch grafts are taken from over the sinus tarsi) primary intention leaving a linear scar 3:1 for closure

what type of wound care dressing has a very high absorbency, maintain a moist environment, and can be used on infected wounds, and raise the temp of the wound?

foam - mepilex, allevyn, polyderm, sof-foam.

what is a superficial contagious bacterial infection of the hair? if this progresses untreated what will it become?

folliculitis - staph aureus - apply moist heat and allow to drain furuncle - moist heat, or I&D may be needed.

which biomechanical condition does not cause compensatory STJ pronation?

forefoot valgus rearfoot varus/valgus and equinus all do

what procedure for the correction of metatarsus adductus is an opening wedge of the medial cuneiform with bone graft?

fowler

what procedure is a medial cuneiform opening wedge with graft?

fowler

what complication of MI would have sudden chest pain/heart failure with cardiac tamponade?

free wall rupture - 5 days to 2 weeks post MI emergent pericardiocetesis

flattening of the metatarsal head on radiographs is a finding consistent with? what patient population is this seen in?

freiberg's disease - most often seen in young women wearing high heels a lot.

what is an inherited disease that results in spinal cord and peripheral nerve degeneration, hypertrophic cardiomyopathy, scoliosis, and decr. sensory function.

friedreich ataxia

what is the incidence of bipartite sesamoids?

from 11% to 35% of the population with 75% of them being unilateral.

when does external rotation occur during the gait cycle?

from stance phase until just after toe off

what flatfoot plane of dominance is the baker procedure performed for?

frontal plane

what flatfoot plane of dominance is the chambers procedure performed for?

frontal plane

what flatfoot plane of dominance is the gleich procedure performed for?

frontal plane

what flatfoot plane of dominance is the koutsogiannis procedure performed for?

frontal plane

what flatfoot plane of dominance is the selakovich procedure performed for?

frontal plane

what flatfoot plane of dominance is the silver procedure performed for?

frontal plane

what does the coronal plane of the CT represent? the axial plane?

frontal plane transverse plane

what partial matrixectomy involves an inverted L through the nail and nail bed with reflection of the matrix off the phalanx?

frost

how would you differentiate a functional vs structural hallux limitus?

functional has decreased dorsiflexion only when the forefoot is loaded and orthotics help. structural has decreased dorsiflexion whether loaded or not, orthotics don't help.

what type of hemolytic anemia is caused by an x linked defect in metabolism seen in african/mediterranean men?

g6pd

on ultrasound you see a well defined anechoic lesion. what is it?

ganglion cyst

what are the surgical podiatric emergencies

gas in the tissue/ gas gangrene/ emphysema compartment syndrome necrotizing fasciitis open fracture/dislocation neurovascular compromise

what are the stance phase muscles? what are the swing phase muscles?

gastroc soleus FHL and FDL ant and post tib EHL, EDL peroneus longus, brevis, tertius

what muscles cross three joints?

gastroc and plantaris - knee, ankle, STJ triceps surae is the combination of both heads of the gastroc, and the soleus

what is the surgical corrections for equinus?

gastroc equinus - proximal recession, distal aponeurotic recession gasto-soleus equinus - sagittal Z lengthening (equal medial and lateral portions), frontal Z lengthening (equal ant. and post. portions)

when performing a tendon transfer, what type of anesthesia may be used?

general spinal epidural must eliminate muscular function/activity

what is another name for a subchondral cyst?

geodes can look a lot like an intraosseous ganglion - but geodes develop later in life usually and have associated arthritic changes.

what pattern of bone destruction has well defined margins with a narrow zone of transition from normal to abnormal bone? This indicates an aggressive or slow growing lesion?

geographic non aggressive/slow growing

a person with sudden onset of polymyalgia rheumatica would be assoc. with?

giant cell arteritis - can lead to blindness start on steroids

Benign but locally aggressive, lytic lesion with moth eaten appearance radiographically?

giant cell tumor Cryosurgery has been utilized more successfully than for any other type of bone tumor.

what is a slow growing lesion with erosion of local bones, are red-brown in color due to hemosiderin, and can seed locally if cut.

giant cell tumor of tendon sheath.

what is a FDL transfer used to correct hammer toes that includes transecting it, splitting it and suturing it around the proximal phalanx?

girdlestone procedure - flexor tendon transfer

what disorder has a defect in GPIIb-IIIa that results in the inability to bind fibrinogen?

glanzmann thromboasthenia

what procedure performed for frontal plane flatfoot deformity is a displaces the calcaneal tuber anteriorly? how does this affect the calc inclination angle?

gleich - increases the calc inclination angle

a reddish blue nail bed lesion displaying myoepithelial cells.

glomus tumor - surgical excision

lesion on the subungual area of her great toe. related intense, lancing type pain that is worse with cold exposure. bluish discoloration. Radiographs showed a well-marginated erosion of the distal phalanx. What is the most likely diagnosis base on the information given?

glomus tumor - surgical excision

what is the antidote for beta blocker overdose?

glucagon

trendelenburg gait would be seen with weakness of what muscles?

gluteus medius

what is the main cause of equinus in diabetics?

glycosylation of collagen resulting in contraction of the achilles tendon. results in forefoot pressures and ulcers

what are the methods of H. pylori testing?

gold standard is gastric mucosal biopsy with rapid urease test fecal antigen test is best initial IgG serology for H. pylori remains positive for life

What is the most common inflammatory arthritis in men over 30?

gout - breakdown of purines/nucleic acids dont see gout in women until after menopause because estrogen is uricosuric. also see gout in renal failure, and psoriasis.

what grades of open fractures should have empiric antibiotic treatment?

grade 2 and 3

what are the grades of pritsch arthroscopic staging of OCDs?

grade I - intact, firm, shiny articular cartilage grade II - intact but soft articular cartilage grade III - frayed articular cartilage

what is the coverage for 2nd gen cephalosporins?

gram pos gram neg (H. flu, Neisseria, proteus, E. coli, KLebsiella, Salmonella, Shigella)

what is the coverage for 1st gen cephalosporins?

gram pos gram neg (proteus, E. coli, KLebsiella, Salmonella, Shigella) anaerobes (not bacteroides)

a benign pearly white papule that spreads to form rings with normal skin at the center.

granuloma annulare

what are the possible methods/theories on breaking up adhesions and scar tissue following surgery or injury?

graston astym - less scar break up

what procedure is a trephined bone graft inserted into the sinus tarsi (which has been trephined) to limit foot pronation, and the keep the STJ from moving?

grice and green extra articular arthrodesis

what is the drug of choice for tinea capitis

griseofulvin

what are the only infectious agents that can cause a fever within a few hours of surgery?

group A strep - gas clostridium perfringens - gas

what is a acutely progressive, but self limiting inflammatory, demyelinating, polyneuropathy resulting in rapid ascending weakness and paralysis from a precipitating infection/viral infection. how is the diagnosis made?

guillain barre - absent DTRs. - *campylobacter* diagnose with electromyography -pos for GQ1b antibodies recovery begins 1-3 weeks after onset. symmetrical muscle weakness beginning in the legs and progressing to the arms.

what conditions are seen with a steppage gait?

guillain barre syndrome CVA paralytic foot drop fascioscapulohumeral dystrophy CMT

what is the classification system for open fractures?

gustillo and anderson

peripheral smear shows cells with fried egg appearance that stain positive for TRAP (tartrate resistant acid phosphatase).

hairy cell leukemia

what disease has a triad of pancytopenia, massive splenomegaly, and dry tap on bone marrow biopsy?

hairy cell leukemia

what is the angle drawn between the 1st metatarsal and the proximal phalanx? what is the normal value?

hallux abductus angle 0-15 deg

what is the most common forefoot fracture?

hallux fracture

what is the result of removing both sesamoids? what can be done to prevent this?

hallux malleus (mallet/hammer) perform an IPJ fusion with jones tenosuspension.

A rubbery and pliable nail plate

hapalonychia usually caused by hyperhidrosis or endocrine disorders

The middle and posterior facets are best seen by which radiographic view?

harris beath or broden views

what is the primary cause of hypothyroidism?

hashimoto thyroiditis - antithyroglobulin and antithyroperoxidase antibodies attack the thyroid gland function. painless goiter on physical exam secondary is due to pituitary disease

what is the classification system for talar neck fractures?

hawkins class type I - non displaced type II - displaced with STJ dislocation - 30% chance of AVN type III - displaced with STJ and ankle dislocation. talus dislocated posteriorly. - 90% chance of AVN. type IV - displaced with STJ,ankle, and TN dislocation. talus dislocated posteriorly. 100% chance of AVN.

what is the sign looking for AVN of the talus following talar neck fracture? what does the positive sign indicate?

hawkins sign - 6-8 weeks post injury positive sign indicates intact vascularity - radiolucency of the talar dome starts from medial and goes lateral. - on canale view *MRI can detect AVN in 3 weeks*

complications of spinal anesthesia are?

headache hypotension cauda equina syndrome infection

what are the most common causes of atrial fibrillation?

heart failure IHD hypertensive heart disease

what are the bony protuberances seen in osteoarthritis? where is each seen?

heberden nodes - DIPJs bouchard nodes - PIPJs

what initiates and ends toe off, the subphase of stance phase?

heel off of the support limb to full strike of the opposite limb.

how does heel pain from plantar fasciitis and heel pain from psoriasis differ?

heel pain from plantar fasciitis is usually at the heel/medial calcaneal tubercle. heel pain from psoriasis is usually most tender at the distal insertion of the plantar fascia, not the calc.

a hard callus on the dorsum of the toe or tip of the toe?

heloma dura

what is a soft interdigital callus with white macerated skin?

heloma molle treatment is fusing the adjacent toes

What is the most common vascular proliferation?

hemangioma

would the hemangioma or port wine stain (nevus flammeus) disappear spontaneously?

hemangioma

bilirubin is a breakdown product of?

hemoglobin A rise in bilirubin will occur if there is excessive destruction of RBCs or if the liver is unable to excrete the normal amount produced

what are the criteria for cancelling elective surgery?

hemoglobin 10mg/dl or less hematocrit 30% or less WBC <2400 or >16000 neutropenia 1k or less platelets less than 50k potassium <3.5 or >5 glucose >200 BUN >50 Creatinine >3.0

what type of anemia is diagnosed by showing schistocytes on peripheral smear? what type of anemia is that?

hemolytic anemia normocytic normochromic anemia

what type of screw has Proximal and distal threads separated by a smooth shaft. Distal threads have a wider pitch, so it enters the bone faster than the trailing threads providing compression. Does generate interfragmental compression, but not a lot

herbert screws or headless compression screw

painful groups of vesicles on an erythematous base along a dermatomal distribution.

herpes zoster (shingles) acyclovir, valacyclovir, famcyclovir most effective in the first 72 hours

Technecium 99 HMPAO stands for what?

hexamethylpropyleneamine oxime

what procedure is a transfer of all the long extensor tendons to the respective metatarsal heads?

heyman procedure

what procedure for the correction of metatarsus adductus is a release of all the soft tissues at the lisfranc joint?

heyman, herndon, strong leaves the lateral and plantar lateral ligaments intact.

what angle is drawn from the long axis of the 1st metatarsal and long axis of the calcaneus on lateral view?

hibbs angle - 135-140 less than 150 is cavus foot

what procedure is a transfer of the EDL tendon slips from their insertion on the distal phalanx of each digit, sutured together and reattached to the 3rd cuneiform or 3rd met base. what are its indications?

hibbs tenosuspension equinus with or without claw toes the EDB tendons are transected and reattached to the stump of the corresponding EDL tendon with the 5th longus attached to the 4th brevis tendon.

what are the three types of long term catheters for administering IV antibiotics?

hickman broviac PICC

what are the radiographic lines when evaluatating congenitally dislocated hip in a child?

hilgenreiner line - connecting the most inferior of the acetabulum on both sides ombredanne line - perpendicuar to hilgenreiner on the most outer aspect of the acetabulum dislocation will show the femoral head outside the lower medial/inside quadrant (usually above it)

what is the point at which the mesotendon attaches to the epitenon?

hilus

when would you perform a percutaneous achilles tenotomy or lengthening for clubfoot?

hindfoot stall

what systemic fungal infx is seen in cave explorers and farmers exposed to bird droppings. will see hilar adenopathy, cavitary lesions in the lungs. how do you treat it?

histoplastomsis itraconazole, severe amphotericin B

a systemic infection usually from inhalation that is found most often in bird and bat manure, chicken and turkey, and most common east of the mississipi.

histoplsamosis

what procedure is a transverse osteotomy in the neck of the 5th met? which is an oblique osteotomy in the neck?

hohmann sponsel and keating

what procedure performed for sagittal plane flatfoot is an opening base wedge of the navicular and medial and intermediate cuneiforms with a TAL?

hoke

diagnosis of a DVT is done with which tests? treatment?

homan's sign - dorsiflexion of the ankle pratt's sign - compression of the calf Ultrasound - (gold standard) venography D dimer of >500ug/ml heparin bolus of 5-10k units IV followed by 500 units per kg per day. INR checked until stabilizes 2.0-2.5 for 3-12 months. OR enoxaparin/lovenox 1mg/kg subQ q12

dorsiflexion of the foot causes deep pain in the calf.

homan's sign - indicative of DVT ultrasound is the gold standard of diagnosis heparin 10k units IV, followed by 500 units per kg every 24 hrs.

what law states: For a material under load, strain is proportional to stress

hooke law

what tests can be used for determining whether a flatfoot is flexible or rigid?

hubscher maneuver - dorsiflex the hallux while the patient is standing, watch for an increase in arch height as you dorsiflex. If the arch increases in height the deformity is flexible, if it does not, the deformity is rigid. jack's test - patient raises their rearfoot off the ground and again, watch for arch height increase. same results as hubscher. coleman block test - test rearfoot rigidity

chorea and behavioral changes followed by atrophy of the caudate nucleus on CT would indicate?

huntington disease

Pigment changes in the eponychium seen with subungual melanoma

hutchinson sign

what type of wound care product promotes moist wound environment, while absorbing excess drainage, and facilitates autolytic debridement, and for use on granular wounds?

hydrocolloids

what type of wound care dressing is indicated for dry wounds where rehydration of an eschar is desired. also useful for deeper wounds such as tendons?

hydrogel - aquasorb, hydron, nu-gel,

what DMARD causes retinal toxicity?

hydroxychloroquine

if you see diastolic HTN without edema, what is probably indicated? how would you treat it?

hyperaldosteronism primary - oral spironolactone or epleronone if surgery is impossible. secondary - angioplasty/stent for renal artery stenosis.

polyuria, polydipsia, polyphagia, weight loss, fatigue and blurred vision are often symptoms of?

hyperglycemia

a tall peaked T wave indicates?

hyperkalemia

what are the symptoms of hypoaldosteronism? hyperaldosteronism?

hyperkalemia, metabolic acidosis, hypotension hypokalemia, metabolic alkalosis, HTN

graves disease is hyper or hypothyroidism?

hyperthyroidism - autoimmune production of thyroid stimulating antibodies

what are the biomechanical aspects of a uncompensated equinus? partially compensated fully compensated

hypertrophic calves STJ supination inverted rearfoot early heel off STJ pronation mild HAV forefoot supinatus STJ pronation valgus rearfoot HAV deformity

would osteoarthritis be primarily a hypertrophic, atrophic, destructive, or inflammatory joint disease?

hypertrophic joint disease

what disease features a systolic murmur that improves with handgrip/squeezing, and worsens with standing?

hypertrophic obstructive cardiomyopathy - autosomal dominant defect resulting in diffuse thickening of the intraventricular septum must place on AICD for pts with history of syncope or family history of sudden death

what would you expect to see in a case of tendinosis/tendon tears on diagnostic ultrasound?

hypoechoic thickening, and the torn portion is heterogenous when compared with the rest of the tendon.

anesthesia in diabetics can mask the effects of hyperglycemia/hypoglycemia?

hypoglycemia

diaphoresis, syncope, tachycardia, hunger, anxiety, tremors, confusion, and weakness are often symptoms of?

hypoglycemia

what is the most common cause of periodic paralysis?

hypokalemic periodic paralysis

What part of the brain regulates the body's temperature?

hypothalamus

what is a common concern during anesthesia of children?

hypothermia and temp fluctuations

general guidelines for using heat vs. cold: if the are is warm to the touch use heat or cold? if there is pain on palpation use heat or cold? if there is swelling during activity use heat or cold? if the pain limits the joints ROM use heat or cold?

ice ice ice ice

most common cause of seizures in children is? in adults over 40?

idiopathic tumor, followed by ischemic stroke

what disorder is diagnosed by a peripheral smear showing antiplatelet antibodies?

idiopathic thrombocytopenic purpura ITP treat with steroids if less than 50k

what is the treatment for macrodactyly?

if asymptomatic - epiphysiodesis - soft tissue cartilage of the physis is surgically resected to stop the bone from lengthening, but will still increase in girth. amputation or partial amputation debulking procedures

at what point do you consider surgery for 5th metatarsal fractures?

if more than 3 mm of displacement if more than 10 deg of angulation

how is a silverskold test interpreted? how does this change treatment?

if the amount of dorsiflexion increases with knee flexion its an equinus due to a tight gastroc because the gastroc crosses the knee. a gastroc recession is supposed to be done only if there is a gastroc equinus and positive silverskold. if there is no positive silverskold a TAL is indicated.

how would you diagnose peptic ulcer disease?

if under 50 - H. pylori test if over 50 upper endoscopy

what is the best source for harvesting cancellous bone? second best?

iliac crest calcaneus

primaxin What is the dose? What is the spectrum of activity? Does it cover MRSA? Pseudomonas?

imipenem/cilastatin 500 mg IV q6-8h (most common) or 1 gm IV q6-8h Very broad spectrum including most Gram positive, Gram negative, and most anaerobes No and no

what are the three main causes of diabetic foot ulcers?

immunocompromised angiopathy neuropathy

a crusted golden yellow plaque that appears stuck on with an erythematous base. what would you treat it with?

impetigo - staph aureus topical mupirocin/bactroban ointment and oral ancef.

what is gadolinium useful for?

in solid lesions with their own vascularity it will uptake more within the lesion. in abscesses and fluid filled lesions it will light up the wall/rim but not within the lesion.

what is the primary cause of radiation induced death?

inability to fight infection because of damage to the bone marrow and bleeding through the GI

on calcaneal intra articular fracture gissane's angle will increase/decrease? on calcaneal intra articular fracture boehler's angle will increase/decrease?

increase - 135 go up to 150 or more decrease 20-40 go down to 20 or less.

what are the causes of impaired wound healing?

increased inflammation - inflammatory phase lasts longer decreased vasculature - macroangiopathy (atherosclerosis), microangiopathy (thick basement membrane), endothelial dysfunction (decr. NO and vasodilation), AV shunting due to autonomic neuropathy, decr. vasodilation due to substance P. decreased catabolism - decreased collagen synthesis, changes to keratinocytes, decreased angiogenesis.

impaired wound healing is due to what three main pillars?

increased inflammation - tissue stuck in inflammatory phase of healing. decreased vasculature - endothelial dysfunction, AV shunting, and macr/microangiopathy. decreased catabolism - decreased collagen synthesis and decreased angiogenesis.

what is the significant of the peroneus brevis tendon being chevron shaped on an axial MRI image?

indicate a longitudinal tear should be a T2 image

is indium or gallium studies more accurate in assessing infection?

indium

what radionuclide dye is useful for identifying leukocyte mediated pathology, eg acute infection?

indium 111 - binds to cytoplasmic components of WBC membranes

is indium more accurate for acute or chronic infections? galium?

indium for acute infections galium for subacute or chronic infection

Which NSAIDs only have anti-inflammatory effects?

indomethacin, tolmetin

what type of bone growth stimulator is larger and heavier but is the least invasive type of bone stimulator that can be placed over a shoe or cast?

inductive coupling two types pulsed electromagnetic field and combined magnetic field

post operative pain that is unresponsive to local anesthetic block and analgesics is usually due to?

infection hematoma dressing pressure

mature neutrophils would be expected in?

infection states

what is infection of the cortex without marrow involvement?

infectious osteitis

what are the phases of bone healing?

inflammation - peaks at 48 hrs soft callus - days to 1-2 months post injury hard callus - 3-4 months if the soft callus connects the fractures remodeling - lasts for several years

albumin would be decreased in?

inflammation and malnutrition

a synovial joint fluid analysis that reveals translucent, yellow colored fluid that has glucose levels less than 50mg/dl, more than 50 PMNs, 2000-75000 WBC, and a low viscosity would indicate what?

inflammatory arthritis

chronic wounds are stuck in what phase of healing?

inflammatory phase

what are the three phases of wound healing?

inflammatory phase - 1-7 days proliferative phase - 5-20 days remodeling phase - 3 wk - 2 yrs

in an open fracture, what is the most crucial first step in treatment?

initiation of broad spectrum IV antibiotics - must be soon as possible! next is irrigation and debridement of tissue. studies show that antibiotics first decreases the risk of infection before the irrigation and debridement (usually in the OR, not bedside) not a podiatric emergency to the OR!!

what toe implants are made of UltraSIL?

integra implants - primus flexible great toe implant, classic flexible great toe, lesser metatarsal phalangeal.

what nerve is seen crossing over the 4th metatarsal on dissection?

intermediate dorsal cutaneous

pain that occurs after a patient has walked a distance, relieved by rest, but begins again after resumed activity.

intermittent claudication - a stage of arterial occlusion inability to meet the metabolic demands of muscle.

what is the best DVT prophylaxis for actively bleeding postoperative patients?

intermittent pneumatic compression

what is the normal amount of hip rotation? hip flexion/extension? hip ab/adduction?

internal/external 35-40 flexion - 90-100, extension - 10-20 abduction - 24-60, adduction <30.

Where do the interossei and lumbricals run in relation to the deep transverse intermetatarsal ligament?

interossei - dorsal lumbricals - plantar

the central compartment communicates to the dorsum of the foot and vice versa via the?

interosseous muscles MPJ communications

a nucleated callus plantar to the metatarsal head.

intractable plantar keratoma (IPK)

what are the two types of subtalar arthroereisis implants?

intraosseous - not used anymore extraosseous: type I - sinus portion only of the sinus tarsi type II - sinus and canalis portion of the sinus tarsi

a bone lesion that is dark on T1, located near the tibial plafond closest to the medial malleolus seen in a young adult would likely be?

intraosseous ganglion

what is the order of muscle involvement in CMT?

intrinsics tib. anterior EDL EHL peroneus brevis *always spares peroneus longus* never affects above the knee

medial osteochondral lesions/ OCDs occur from what mechanism of injury? lateral osteochondral lesions/ OCDs occur from what mechanism of injury? which lesion would be deep cupped shape, and which would be a shallow wafer shaped?

inversion and plantarflexion - posteromedial lesion - deep cup inversion and dorsiflexion - anterolateral lesion - shallow wafer DIAL a PIMP Dorsi inversion - anterolateral, Plantar Inversion - Medialposterior

what is the mechanism of injury in a lateral talar dome osteochondral lesion?

inversion of the foot with the ankle dorsiflexed.

what is the mechanism of injury in a medial talar dome osteochondral lesion?

inversion of the foot with the ankle plantarflexed

what EKG pattern indicates ischemia?

inverted T wave

plantar fibromatosis usually occurs in what structure?

involving the medial aspect of the central bands of the plantar fascia of the foot usually in males

what is a pathognomonic sign for pigmented villonodular synovitis on MRI?

iron deposition in the tumor

what type of contact dermatitis causes immediate reaction from a single exposure? what type results from exposure sensitizing to future contact (first contact causes no response)?

irritation contact dermatitis allergic contact dermatitis

muscle contraction that is not associated with joint motion? muscle contraction that is associated with joint motion? muscle contraction in which the muscle lengthens while contracting? muscle contraction in which the muscle shortens while contracting?

isometric isotonic eccentric concentric

what are some facts to remember when using a medial heel skive?

it shifts the ground reactive forces medially cannot be used with a shallow heel cup

what are the stages of quenu and kuss classification system, and what is it for?

its for lisfrancs injuries homolateral - all 5 mets displaced in the same direction isolateral - one or two mets displaced from the others divergent - displaced mets in both sagittal and coronal planes

describe the cierny-mader classification? what is cierny-mader class for?

its for osteomyelitis in adults Stage 1 - medullary stage 2 - superficial cortex stage 3 - localized (only the cortex) stage 4 - diffuse (cortex and medu canal) A: normal healthy host Bs: systemically compromised Bl: locally compromised host C: treatment worse than the disease

the ankle joint is most stable in what position?

its maximally dorsiflexed position.

What is another name for the flexor retinaculum? What is another name for the superior extensor retinaculum? What is another name for the inferior extensor retinaculum?

laciniate ligament transverse crural ligament cruciate crural ligament

what ligament must be transected when performing a tarsal tunnel release?

laciniate ligament/flexor retinaculum

what is the marker for cellular hypoxia?

lactate at >4 mmol/L

what is a dwyer procedure?

lateral closing wedge osteotomy of the calc to correct rigid calcaneovarus

which side of the talus has greater incidence of OCDs? why?

lateral edge wider trochlea in front than behind, posterior is beveled and triangular

what is the incision approach in calcaneal fractures? what structures are preserved?

lateral extensile incision - 90 deg or curved full thickness to bone and the flap is lifted subperiosteally to protect the peroneal tendons, sural nerve, lateral calcaneal artery and extensor retinaculum.

what are the two incisions for a triple arthrodesis?

lateral incision from the tip of the lateral malleolus to the base of the 4th metatarsal. -Avoid superficial peroneal nerve and peroneal tendons medial incision from the medial gutter of the ankle to the 1st metatarsal base.

pain elicited by plantarflexing the foot, and dorsiflexing the hallux. what pathology are you looking for? what is the common mechanism of injury?

lateral process fracture of the talus - snowboarders fracture by putting tension on the flexor hallucis longus which crosses the process. dorsiflexion eversion.

On lateral radiograph you see a V sign. what is indicated?

lateral process of the talus fracture - snowboarders fracture

what is the radiographic hallmark of skewfoot?

lateral subluxation of the navicular on the talar head characterized by forefoot adduction and hindfoot valgus, normal midfoot. https://images.radiopaedia.org/images/4427453/7225ad1e968181963616d792da082c_gallery.jpg picture of the lateral subluxation.

what ligament primarily limits the inversion of the STJ? what ligament primarily limits the eversion of the STJ?

lateral talocalcaneal/cervical ligament interosseous

what structure is the landmark for for anterocentral arthroscopic portal location?

lateral to EHL tendon

What conditions may be associated with plantar fibromatosis?

ledderhose dupuytrens - alcoholism and cirrhosis peyronies

when fixating a fracture with an IM nail in the presence of a hematoma, what is done to the hematoma?

left alone - left undisturbed

congenitally dislocated hip is most common on which side? seen more with what presenting factors?

left side 60% also seen more in breech, first born, females, joint laxity, older sibling also has it.

a benign errector pili smooth muscle tumor.

leiomyoma

what are the possible treatments for brachymetatarsia?

lengthening the short met via callus distraction or bone graft. shortening the long adjacent metatarsals. must do concurrent V-Y skin plasty, with EHL, EDL lengthening with callus or bone graft lengthening.

what procedure for the correction of metatarsus adductus is a closing base wedge osteotomy of 1 and 5, with oblique rotations of the central 3 mets?

lepird

the ultrasound bone stimulators use low or high intensity pulsed ultrasound?

low intensity pulsed ultrasound (LIPUS) high intensity is used for PT and contraindicated in fractures.

what are painful, subcutaneous red streaks along the skin?

lymphangitis - inflammation of lymphatic vessel by infection.

what is the accumulation of fluid and swelling of the subcutaneous tissue?

lymphedema - not fat, still fluid but *nonpitting* due to swelling of subcutaneous tissue since the lymph vessels are destroyed.

would lymphedema or lipedema have involvement of the feet?

lymphedema. lipedema has no foot involvement, strictly between the feet and hips. bilateral, painful, and bruises easily.

who first described a percutaneous bunnell type stitch for achilles repair?

ma and griffith

flat, discolored well circumbscribed skin lesion up to 1cm? flat, discolored well circumbscribed skin lesion >1cm?

macule patch

what disease is characterized by multiple enchondromas with soft tissue hemangiomas?

maffuccis disease most are malignant

what is the purpose of reaming for intramedullary nail use?

makes the canal wider for larger IM nail results in less nonunions less broken bolts quicker healing by more blood flow (too much reaming can result in osteonecrosis or fat emboli)

in regards to clubfoot, is it more male/female? left or right? bilateral/unilateral?

male rigt foot 50% bilateral

what is the most common soft tissue sarcoma, and is most commonly associated with paget's disease?

malignant fibrous histiocytoma

most common cause of temperature elevation intraoperatively?

malignant hyperthermia

continuous retching, usually after binge-drinking, that causes sudden bright red hematemesis?

mallory weiss syndrome - tear in the esophagus

a non healing ulcer of many years as a result of a burn?

marjolin's ulcer - assoc. with chronic OM 90% are as a result of a burn

what procedure is a removal of 1/2 to 2/3 of the 5th metatarsal? which is removal of the entire 5th metatarsal?

mckeever brown for tailors bunions

what are the angles you would evaluate in a cavus foot deformity?

meary's angle - normal 0, cavus >6 Calc incl. - normal 20-25, cavus <30 hibbs angle - normal 135-140, cavus >150

when taking isherwood 3 position radiographs to visualize the entire STJ, which position best visualizes each facet of the STJ?

medial oblique axis visualizes middle and posterior facets oblique dorsal plantar visualizes anterior facet lateral oblique axial the posterior facet

what are the branches of the tibial nerve that divide within the flexor retinaculum?

medial plantar nerve, lateral plantar nerve, medial calcaneal nerve

where does the gastroc and soleus insert in relation to the STJ axis?

medial to it

patient presents with anterolateral ankle pain especially when climbing stairs and on dorsiflexion and eversion; history of ankle sprain, negative talar tilt, and anterior drawer test. stress radiographs are also negative. what is the diagnosis and treatment?

meniscoid body - tx is an ankle scope

a delicate connective tissue sheath attaching a tendon to its fibrous sheath and allows blood supply to be transferred from the paratenon to the tendon?

mesotenon

what are the possible causes of hallux rigidus/limitus?

met primus elevatus hypermobility long first ray DJD trauma septic joint iatrogenic neuromuscular disease arthritis

in terms of causes of gout, an overproducer is classified as? an underexcreter is classified as? what is the best medication for each type?

metabolic gout - caused by genetics or tumor - allopurinol (best for both) renal gout - probenecid (only underexcretor), allopurinol (best for both)

what is the process that causes black and gray discoloration of the tissue around an implant with release of corrosion debris, and flaking of the implant? what is the process that produces corrosion resistance by a surface of reaction products?

metallosis passivation

what are the three categories of materials used as biomaterials?

metals polymers ceramics

what are the possible modifications to remove pressure from the metatarsal heads?

metatarsal bar metatarsal pad minimal arch fill orthotic - creates almost a total contact surface. leaving the anterior shell edge full thickness - this creates almost a step off and rocker effect.

what can help a patient ambulate in shoes after 1st MPJ arthrodesis when they have inability to dorsiflex?

metatarsal bar on the sole of the shoe

what medication must be stopped before doing an angiogram?

metformin - patient can develop metabolic acidosis

should diabetic medications be held on the morning of surgery or given?

metformin should be stopped 24 hrs prior and started 48-72 hrs after - lactic acidosis risk long acting insulins - given half dose the morning of surgery, and sliding scale insulin intraop.

what is the treatment of subclinical hyperthyroidism?

methimazole if TSH is <0.1

what is the best DMARD? what are its adverse effects?

methotrexate lung and liver toxicity, bone marrow suppression

what medications would you want to use to treat reiter's disease/reactive arthritis? in the presence of HIV would that change?

methotrexate and azathioprine sulfasalazine and etretinate

what is the antidote for nitrites overdose?

methylene blue

what part of the navicular is the most avascular?

middle 1/3rd

which facet is most commonly fused in a talocalcaneal coalition?

middle > anterior > posterior

what is the most commonly affected STJ facet in a talocalcaneal coalition?

middle facet

hypercalcemia, metabolic alkalosis with renal failure would indicate?

milk alkali syndrome due to calcium carbonate from PTH suppression from renal failure.

what cardiac condition is most often caused by viral infection of coxsackie B virus? how would you diagnose it?

myocarditis - in south american patients - think chagas disease caused by trypanosoma cruzi (treat with benznidazole) diagnosis is by increased cardiac enzymes in a normal EKG and echo. gold standard is myocardial biopsy

What is the only nonacidic NSAID?

nabutetone

young boy of 5 who has pain in his arch and walks on the lateral aspect of his foot and shows silver dollar sign or coin on edge sign on radiographs is indicative of?

navicular AVN/osteochondrosis - kohler disease - navicular becomes sclerotic and flattened self limiting over 2-4 years.

what dermatic lesion precedes the onset of diabetes in 15-20% of patients?

necrobiosis lipoidica diabeticorum 90% of lesions are on the shins

what is a red or brown macular lesion that slowly expands on the shins, but is well demarcated? what does it indicate?

necrobiosis lipoidica diabeticorum precedes the onset of diabetes in 15-20% of patients.

what are the common anaerobic bacteria?

neg rod - B. fragilis pos rod - C. perfringens, difficile, tetani pos cocci - peptostreptococcus

what are the two types of schwannomas? which is centrally located? which is eccentrically locate? which requires entire nerve segment excision?

neurofibroma - centrally located - excision neurilemmoma - eccentrically located - nerve is usually non damaged.

what are the two causes of diabetes insipidus? how do you treat each?

neurogenic DI - deficiency of ADH production - SubQ vasopressin/desmopressin/DDAVP will show return to baseline in 1-2hrs. nephrogenic DI - kidneys unable to respond to ADH - give DDAVP/desmopressin which will have no effect. - treat with thiazide diuretics.

what are the stages of the liverpool classification system of ulcers?

neuropathic ischemic neuroischemic uncomplicated or complicated

what are the two conflicting etiologies for charcot?

neurovascular french theory - charcot neurotraumatic german theory - virchow and volkman

what is the radiolucent area on lateral view of the calcaneus that has pressure trebeculae from the STJ, and traction trabeculae from the achilles?

neutral triangle

what is the finding in which the top layer of skin slips away from the lower layer when rubbed slightly creating a blister? what condition is this associated with?

nikolsky sign - seen in bullous diabeticorum

should asymptomatic patients with multiple risk factors for coronary artery disease be stress tested?

no - only symptomatic patients or those with abnormal EKG should be stress tested.

would you attempt to remove the embolism from acute arterial thrombosis?

no - treatment is thrombolysis using tpa, strepto or uro kinase.

does the extensor apparatus have attachments to the proximal phalanx? if so what are they called?

no it has no attachments to the proximal phalanx

Can allopurinol, probenecid or sulfinpyrazone be used for acute gout?

no they will cause initial hyperuricemia and will start a gouty attack

how would you determine a non gonococcal septic arthritis from a gonococcal septic arthritis? what is the most likely organism of each? which is most common? how do you treat it?

non gonococcal is usually one joint - staph aureus - most common type of septic arthritis. gonococcal is multiple joints and migratory arthralgia, and petechial rashes - gonorrhea treat with ceftriaxone and vanc combo.

biopsy shows LDH, and beta-2 microglobulin markers.

non hodgkin lymphoma

what are the benefits of amniotic tissue allografts?

non immunogenic antibacterial properties matrix for cellular migration and proliferation reduce scar tissue reduce inflammation reduced pain

a synovial joint fluid analysis that reveals transparent, straw colored fluid that has glucose levels equal to blood, less than 25 PMNs, 200-2000 WBC, and a high viscosity would indicate what?

non inflammatory arthritis

what is the treatment of a hypertrophic non union? of an atrophic non union?

non weight bearing, and bone stimulator. surgical excision of necrotic bone, immobilization, bone stimulator. bone stim is useless for pseudoarthrosis if the gap is 1/2 the diameter of the bone.

hemangiomas - soft bright red vascular nodules require what treatment?

none - disappear by age 5

if you transfer a muscle out of phase, how much strength and activity does it regain?

none usually only acts as a brace or sling

Benign connective tissue lesion with fibrous replacement of bone?

nonossifying fibroma

oreo cookie sign on arthrogram would indicate?

normal healthy ankle cartilage dark bands of the articular cartilge with white radiopaque dye between them. if damaged the white dye will leech into the cartilage and subchondral bone.

Casts are a general indicator of kidney disorders. Named because their shape represents the cylindrical shape of the kidney's tubular lumen what do hyaline casts represent? RBC CASTS WBC CASTS EPITHELIAL CASTS GRANULAR CASTS WAXY CASTS FATTY CASTS

normal unless very numerous, which could be due to low urine flow. Indicate glomerulonephritis Indicate pyelonephritis Indicate tubular damage nonspecific and associated with any form of nephritis. Waxy casts are the end stage of granular casts. Occur in any form of nephritis, esp. nephrotic syndrome and Fabry dz

hemolytic anemia is what type of anemia? how is it diagnosed?

normocytic anemia reticulocyte count - increased - hemolytic - decreased - hypoproliferative

what are a couple of scales you can use to determine how likely a patient is to develop pressure ulcers?

norton or braden scale

What is a differential diagnosis for antero-lateral ankle pain after a sprained ankle?

o OCD of the talus* o Anterior impingement syndrome o Sinus tarsi syndrome o ATFL rupture o CFL rupture

what graft is a pig small intestine submucosa?

oasis

what is the closed kinetic chain position of the midtarsal joint?

oblique axis is pronated, longitudinal axis is supinated.

what is an other name for the lisfranc ligament?

oblique interosseous ligament

what is another name for the lisfranc ligament?

oblique interosseous ligament

what is a clinical distinction that can be made between vertical talus and oblique talus?

oblique talus is reducible, while vertical talus is not.

what is the orientation of the primary fracture line in calcaneal fractures?

obliquely from posteromedial to anterolateral the primary fracture line is always the same, secondary fractures/lines are variable depending on direction of force.

would obstructive or restrictive lung disease have a decreased FEV1/FVC ratio? would obstructive or restrictive lung disease be greater than 70% of predicted? would obstructive or restrictive lung disease be less than 70% of predicted?

obstructive lung disease - COPD, Asthma, emphysema (restrictive is normal FEV1/FVC ratio) restrictive obstructive

what disease is characterized by multiple enchondromatosis?

olliers disease

what osseous procedure are performed for clubfoot?

only after 1 year old lichtblau - calc dillwyn - cuboid calc osteotomy evans - calc ganleys - cuboid all are closing wedges of the lateral column to shorten the lateal column.

what antibiotics cannot be mixed with PMMA beads cement?

only heat stable antibiotics can be mixed. clindamycin is not heat stable

when would you perform an angiography in a patient with a valvular disease?

only in those patients who have indications for valve replacement surgery

how does the jahss classification affect treatment of turf toe?

only the type I is treated with ORIF because of the difficulty in close reduction. type II is closed reduction treat with strapping, splinting, RICE, and prevention of dorsiflexion with shoes.

Hypertrophy of the nail breaking down of the nail separation of the nail from the bed, starting distally. separation of the nail from the bed, starting proximally. a callus in the nail groove. abnormally brittle nails

onychauxis onchoclasis onycholysis onychomadesis onychophosis onychorrhexis

what describes movement of a bone around a joint in a body part that is non weight bearing?

open kinetic chain closed kinetic chain is weight bearing

what are the most common clinical signs in graves disease? what is the treatment of graves?

opthalmopathy, and dermopathy as well as diffuse goiter PTU, methimazole

what are the five pillars of wound care?

optimize perfusion - PVRs, ABIs treat infection control edema offload pressure moisture balance - should be like a damp wrung out towel.

what is the treatment of acute gout in renal disease?

oral or injectable corticosteroids PT sympathectomy by blocking the nerve and resulting in vasodilation and washes out the joint.

when throwing a syndesmotic screw, what is its orientation? how many cortices?

oriented 30 deg from posterior lateral to anteromedial, 4-5cm proximal to the tibial plafond 3 cortices - easier to remove, not as much stiffness 4 cortices - more stable, higher rate of stiffness.

what is the platform that allows weight bearing images of the foot and ankle to be obtained?

orthoposer

which test for congenitally dislocated hip relocates the hip into the acetabulum? which test dislocates the hip from the acetabulum? which sign is looking at gluteal folds? the dislocation is on what side? which sign looks at a lower knee position while supine and the legs flexed up?

ortolani sign barlow sign anchor sign - the side with more folds is dislocated. galeazzi sign

what is the test for congenitally dislocated hips in newborns? what is the test for a hip that is dislocatable, but not dislocated?

ortolani test barlow test

on radiograph you see an intracortical osteolytic lesions with ground glass appearance with bubbly area clearly delineated by a band of sclerosis.

ossifying fibroma asymptomatic

patient who has joint stiffness lasting less than 20 mins upon wakening would have what type of arthritis? what joints are most affected? patient who has joint stiffness lasting more than 30 mins upon wakening would have what type of arthritis? what joints are most affected?

osteoarthritis - PIPJ and DIPJ, and knees RA - PIPJ only, never DIPJ, knees, wrists,

apaptite crystals, (small chunky rods) would be found in the synovial analysis of what disorder?

osteoarthritis and inflammatory arthritis

on radiograph you see a well circumscribed expansil, osteolytic lesion of more than 1 cm, with areas of calcification and cortical thinning. is the pain relieved with aspirin?

osteoblastoma not relieved by aspirin

what is a subset of osteochondral defects which include, Osteochondral fractures, Avascular necrosis, and Degenerative arthritis?

osteochondritis dessicans

radiographical appearance of a Cartilage-capped, hyperplastic bone pointing away from the joint most often seen subungually in the foot.

osteochondroma

Differential Diagnosis for subungual exostosis?

osteochondroma glomus tumor

what is the bony scaffold on which creeping substitution can occur? what is the presence of a bone morphogenic protein inductor substance?

osteoconduction osteoinduction

What is the most common, malignant, primary bone tumor?

osteogenic sarcoma Multiple myeloma - is more common than osteogenic sarcoma but is often considered a marrow cell tumor vs. a bone tumor.

what bone tumor would be seen in a teenage male with night pain that is relieved by aspirin or NSAIDs. shows a bulls eye appearance on xray. how do you treat it?

osteoid osteoma in order to prevent recurrence on removing it surgically you must excise the central lucent nidus.

What is the most common bone tumor associated with Paget disease?

osteosarcoma

What malignant bone degeneration may be seen with Paget disease?

osteosarcoma

what is the most common primary malignant bone tumor?

osteosarcoma

Sunburst periosteal reaction with Codman triangle and cloud-like, dense bone formation

osteosarcoma - most common primary malignant bone tumor

what are the rules that are in place to determine whether radiographs are needed following ankle sprains?

ottawa ankle rules bone tenderness at the distal 6cm, or tip of the tibia and fibula. base of the 5th met, navicular, or inability to bear weight/walk.

the most common complication of gastroc recession is?

overlengthening

what determines the speed of onset of local anesthetics? what determines the potency of local anesthetics? what determines the duration of action of local anesthetics?

pKa - the smaller the pKa the faster the rate of anesthetic onset - lidocaine, prilocaine, etidocaine. lipid solubility protein binding

what are the contraindications to MRI?

pacemaker metal clips, valves, or stints slivers of metal in the eye cochlear implants stents internal fixation - 6 weeks

a skull xray with hair on end or cotton wool appearance changes would indicate? how would you diagnose it? what is the first line tx?

pagets disease bone scan plus high alk phos bisphosphonates are first line tx

patient with bony bowing of the legs, increased skull growth, and deafness with elevated alkaline phosphatase would indicate? how would you diagnose it? what is the first line tx?

pagets disease bone scan plus high alk phos bisphosphonates are first line tx

what is the sequence of sensations of nerve recovery after injury?

pain temp touch proprioception motor

what is the order of sensations lost when using a local anesthetic?

pain temperature touch proprioception skeletal muscle ability

what sensations are lost first during anesthesia?

pain and temp first, touch and motor second

what are the enzymatic wound debridement agents?

panafil, collagenase, santyl, accuzyme

what type of thyroid cancer most commonly arises in patients who had previous radiation exposure?

papillary carcinoma surgeons and techs who don't wear thyroid shields.

what are the two layers of the dermis? which layer has meissner corpuscules, and which has pacinian corpuscles? what does each corpuscle sense?

papillary layer - upper 1/3 - meissner corpuscles (light touch) reticular layer - lower 2/3 - pacinian corpuscles (vibration/pressure)

what complication of MI would have pansystolic/systolic murmur in the cardiac apex radiating to the axilla?

papillary muscle rupture - 2-7 days post MI emergent surgical repair after echo confirms diagnosis

elevated well circumscribed, skin lesion up to 1 cm? elevated well circumscribed, skin lesion <2 cm? elevated well circumscribed, skin lesion <3 elevated well circumscribed, skin lesion >3

papule plaque nodule tumor

a systemic infection usually from inhalation that is most common in brazil, and has a steering wheel appearance on microscope?

paracoccidioidomycosis

what is the loose areolar tissue surrounding the entire tendon that allows the tendon to slide?

paratenon

what supplies the majority of a tendon's blood supply?

paratenon

lead pipe rigidity with resting tremor that improves with action would indicate?

parkinsons if less than 60 - benztropine (anticholinergics) if more than 60 - amantadine if severe - levodopa/carbidopa

what type of EKG cardiac rhythm shows a series of rapid beats at a regular rate between 150-250bpm and begins and ends suddenly?

paroxysmal atrial tachycardia or paroxysmal supraventricular tachycardia

a continuous machine like murmur that is loudest at the 2nd intercostal space would be?

patent ductus arteriosus

are innocent or pathologic murmurs constant with respirations?

pathologic

what is the treatment modality for a positive ortolani sign in an infant?

pavlik harness

what procedure for the correction of metatarsus adductus is an excision of the base of the three central mets with osteotomy of the 5th.

peabody-muro

when should peak and trough levels be taken for vancomycin? what should the levels be?

peak - 30 mins after 3rd dose - 15-30 mg/mL trough - 30 mins after 4th dose - <10 mg/mL

A UCBL device is best indicated for? university of california biomechanical laboratory

pediatric flexible deformity

what does a positive nikolsky sign indicate?

pemphigus vulgaris - no basement membrane disruption

Upper GI bleeding originates above the ligament of Treitz usually presents as hematemesis or melena. what are the most common causes? Lower GI bleeding originates below the ligament of Treitz usually presents with wine-colored or bright-red blood per rectum. what are the most common causes?

peptic ulcers, gastric erosions, esophageal varices diverticulosis, arteriovenous malformations (meckel diverticulum)

what is the most common causitive organism of necrotizing fasciitis?

peptostreptococcus, S. aureus, strep pyogenes, clostridium, and bacteroides.

what are the common anaerobic gram positive cocci?

peptrostreptococcus

what is the best way to make the bone cut when performing tension stress lengthening with external fixator? what is the best location to make that cut?

percutaneous subperiosteal corticotomy with a gigli saw or osteotome metaphysis of bone

JVD with hypotension, clear lungs, and decreased lung sounds would indicate? how do you treat it?

pericardial tamponade - those three are called beck's triad emergent pericardiocentesis

increased pain with inspiration, decreased by sitting up and leaning forward would indicate? how do you diagnose it?

pericarditis caused by cocksackie B virus EKG shows PR interval depression and diffuse ST segment elevation

what is a fibrous tumor seen in/around the nail bed that are painless and don't develop until puberty. usually seen in patients with tuberous sclerosis.

periungual fibroma

what pattern of bone destruction poorly defined margins with a wide zone of transition from normal to abnormal bone, not easily discerned from normal bone? This indicates an aggressive or slow growing lesion?

permeative aggressive, rapidly growing seen in malignancies

what is the primary stabilizer of the first ray during midstance?

peroneus longus

which muscles insert on the base of the 1st Metatarsal?

peroneus longus and tibialis anterior

what is the peroneus longus tendon transfer? what are its indications?

peroneus longus is released at the level of the cuboid, transferred to 3rd cuneiform or 3rd met base, can also be split and half anastomosed to the tibialis anterior, and half to the peroneus tertius. indications are drop foot and pes cavus

what tendon transfers could you perform for a drop foot?

peroneus longus tendon transfer- in phase TATT - in phase PT tendon transfer - out of phase

what is the test used to detect deep vein valvular incompetence?

perthes test - Tq placed around the elevated mid thigh or proximal calf and inflated to 30-60mmhg, patient asked to walk. if pt feels pain on walking there is deep venous claudication.

Multiple hyperplgmented spots on lips and buccal mucosa. Multiple hamartomous polyps

peutz jeghers syndrome

factors that affect the concentration of a drug at a site of action, as a function of time is referred to as?

pharmacokinetics

what disorder is characterized by the P's: pallor, palpitations, panic, pounding headache, perspiration, Pain, Pressure (HTN). what is it caused by?

pheochromocytoma excess catecholamines

in what patients is epinephrine contraindicated?

pheochromocytoma hyperthyroidism and thyrotoxicosis severe hypertension severe PVD tricyclic antidepressants (MAOIs)

what angles would you want to evaluate in retrocalcaneal pathology?

philip fowler angle - 44-69 total angle of ruch - calc incl + philip fowler - greater than 90 is haglunds. parallel pitch lines

what is a noninvasive way of delivering chemicals through the skin using ultrasound waves? using direct current?

phonophoresis iontophoresis 5-6 cm

what radiographic effect occurs at lower kVp when an xray photon collides with a lower shell electron, the electron is ejected and the higher shell electron fills its space releasing energy? it causes more/less radiation? it is good/bad for the image?

photoelectric effect beneficial to the image, but greater radiation to the patient.

what is sequestrum? what is involucrum?

piece of dead bone floating in pus/inflammation sheath of bone surrounding the pus/inflammation.

what are benign herniations of subcutaneous fat into the dermal connective tissue found frequently on the lateral and medial aspect of the weight-bearing heel? what is the treatment?

piezogenic pedal papules less than 10mm in size can have a cobblestone appearance when multiples. treat with heel cupping orthoses and weight loss

what is diabetic dermopathy caused by?

pigmentation is due to hemosiderin deposits. no treatment

synovium that is red-brown in color due to hemosiderin deposits is most likely due to?

pigmented villonodular synovitis

Radiographs demonstrate "juxta-cortical erosions" of both sides of an affected joint.

pigmented villonodular synovitis Represents a rare tumor of the synovium and tendon sheath

a condition that causes the synovium to thicken and overgrow. The condition can lead to bony erosions and arthritis. Upon initial presentation, symptoms have often been present for years and include vague pain, joint effusion, limited ROM.

pigmented villonodular synovitis The symptoms arise from excessive fluid being produced in the joint. treatment is fusion of damaged joints. synovium is red-brown in color due to hemosiderin deposits.

which penicillins cover pseudomonas?

piperacillin, zosyn, ticarcillin, timentin, ....

Zosyn what is the dose? what is the indication? what is the spectrum of activity? does it cover pseudomonas?

piperacillin/tazobactam 3.375 g IV q6h renal dose - 2.25 g IV q6h alternate dose - 4.5 g IV q6h moderate to severe diabetic foot infections staph, strep, enterococci, gram negs anaerobes. yes

a superficial pitting to the stratum corneum on the sole of the foot, giving a moth eaten appearance. how would you treat it?

pitted keratolysis - from corynebacterium or micrococcus topical erythromycin

what structure supports the head of the talus?

plantar calcaneonavicular ligament - spring ligament

turf toe is an injury to what?

plantar capsular ligament complex and ligaments

with regards to metatarsal fractures, which direction of displacement of the capital fragment is least tolerated?

plantar displacement

what are the components of the steindler stripping?

plantar fascia long plantar ligament abductor hallucis FDB abductor digiti minimi all stripped from the periosteum of the calcaneus

on diagnostic ultrasound you see fusiform shaped heterogenous hypoechoic mass. what is it?

plantar fibromas

which joints does the flexor digitorum brevis exert action on? the flexor digitorum longus?

plantarflexes the MTPJ and PIPJ. inserts at the middle phalanx of 2,3,4,5. plantarflexes the DIPJ, PIPJ, MPJ in that order

what is the common mechanism of anterior process of the calcaneus fractures?

plantarflexion and inversion

esters are hydrolyzed through the? amides are hydrolyzed through the? which is more reactive? why?

plasma liver esters due to PABA (para aminobemzoic acid)

in a disorder of excess catecholamines, how would you test it?

plasma free metanephrine and normetanephrine or 24 urine for catecholamines and vanillylmandelic acid and metanephrines. pheochromocytoma

what are the phases of skin graft healing

plasmatic imbibition - 24-48hrs - skin graft absorbs nutrients by diffusion inosculation - day 3 - capillary buds make contact with graft. angiogenesis/revascularization - day 5

what partial matrixectomy involves excision of a pie-shaped wedge of tissue taken from the side of the toe. Useful only in cases of hypertrophy of the ungualabia.

plastic lip

what are the three subtypes of juvenile rheumatoid arthritis? which is associated with eye problems?

polyarticular - many joints pauciarticular - less than 4 joints - assoc. with iridocyclitis systemic (still disease) - splenomegaly, adenopathy.

patient has intense itching after hot showers, facial plethora, and TIAs or stroke? how do you diagnose it? how do you treat it?

polycythemia vera serum EPO (incr - secondary polythemia, decr - primary polycythemia) phlebotomy to lower hematocrit JAK2 positive

what is a hyperkeratotic papule caused by hypertrophy of the stratum corneum around a sweat duct/gland?

porokeratosis plantaris discreta (PPK)

how do you diagnose hematogenous OM?

positive blood cultures and positive bone scan.

what is the most common cause of osteoporosis?

post menopausal women celiac disease - 2nd steroid use

most important facet in calcaneal repair/fracture is the?

posterior facet 2:1 inversion to eversion

what aspect/fragment of an ankle fracture is most responsible for ankle arthritis?

posterior malleolar fracture fragment

what is the target of the harris beath view?

posterior talocalcaneal joint

what is the primary supinator of the foot? what is the primary evertor of the foot? what is the primary pronator of the foot?

posterior tibial peroneus brevis peroneus longus

In a case of dropfoot associated with charcot marie tooth disease, what is the BEST tendon to transfer to combat this disease?

posterior tibial - because the disease affects this muscle/tendon last/rarely. second best would be peroneus longus because it too has a lower risk of affect with the disease.

which muscles lock the midtarsal joint in late midstance and propulsive periods?

posterior tibial, peroneus longus and peroneus brevis

when describing polydactyly, would an extra digit located on the medial side by preaxial or postaxial? located on the lateral side? which is more common?

preaxial postaxial - 80% of the time

what type of EKG cardiac rhythm shows P waves appearing early and abnormally shaped or may be lost to the previous T wave?

premature atrial contractions caused by coffee, tobacco, alcohol, heart disease, CHF< hypoxia

during contact phase of the gait cycle, what is the function of the gastrocnemius muscle?

prevents the knee from hyperextension

what is the biggest risk factor for DVT?

previous DVT

contraindications to a tourniquet would be?

previous graft/bypass sickle cell

what are the independent risk factors for osteomyelitis?

previous history of a wound recurrent or multiple wounds wounds that extended to the joint or bone.

what are the manifestations of hyponatremia? what is the treatment?

primarily neurologic, lethargy, headache, confusion. restrict ater intake and promote water loss. replace sodium deficits.

hyperaldosteronism is divided into primary and secondary, what causes each?

primary - excess aldosterone secondary - excess renin

what are the two types of bone healing? which is intramembranous and which is endochondral? what are the methods of healing?

primary - intramembranous - heals by haversian remodeling secondary - endochondral - heals by cartilaginous and fibrous callus formation which is later remodeled.

a high serum calcium, low serum phosphate, and elevated parathyroid hormone (PTH) would indicate? a low or normal serum calcium with an elevated parathyroid hormone (PTH) would indicate?

primary hyperparathyroidism secondary hyperparathyroidism

a bone biopsy showing extensive fibrosis or "dry tap", would indicate?

primary myelofibrosis

what type of angina is relieved by Nitro, often at rest or night with an ST elevation?

prinzmetal/coronary spasm angina

what drug will decrease the serum concentration of penicillin and most cephalosporins?

probenecid

what drugs can cause drug induced lupus? what test screens for lupus?

procainamide, hydralazine, chlorpromazine, isoniazid, penicillamine, griseofulvin PiG CHIP anti dsDNA

during which phase of wound healing is granulation tissue produced? during which phase does a lattice like network of type I collagen form?

proliferative maturation/remodeling

is the subtalar joint pronated or supinated during running?

pronated the entire time

what is the mechanism of injury of high ankle sprains?

pronation, eversion, dorsiflexion results in syndesmotic injury/high ankle sprain.

what IV anesthetic is mediated by GABA, and the high lipid solubility results in rapid onset and lasts only minutes? what IV anesthetic depresses RAS (reticular activating system), is structurally unrelated to others, has a safe cardiovascular profile, and does not drop blood pressure, but does drop intracrannial pressure while maintaining arterial pressure

propofol etomidate

what is the antidote for heparin overdose?

protamine sulfate

what is the treatment for AVN?

protected non weight bearing bone stim.s vasodilators, nsaids debridement of necrotic bone with autogenous bone graft.

what is the role of the pretibial muscles at contact period of the gait cycle in normal gait?

provide an unstable midtarsal joint for shock absorption and adaptation

what is a fibrocartilaginous interface between two fracture fragments?

pseudoarthrosis

the most likely orgnism in a infected, macerated ulcer?

pseudomonas

what disorder has bony sclerosis that is termed "ivory phalanx"?

psoriatic arthritis

what is the classification system of chronic achilles pathology?

puddu peritendonitis - inflammation of surrounding tissues, not the tendon. tendonosis - intra tendinous degeneration. peritendonitis with tendonosis - combination of the two.

what is the gold standard of diagnosing a Pulmonary embolism PE?

pulmonary angiography, spiral CT or V/Q study or CXR secondary.

a diastolic decrescendo/crescendo-decrescendo that is louder on inspiration would be?

pulmonic regurgitation

a mid systolic, crescendo-decrescendo murmur that is louder on inspiration with a click would be?

pulmonic stenosis

what are the two types of inductive coupling bone stimulators? which has a time varying magnetic field producing an induced electric field? which has a time varying magnetic field superimposed on a static magnetic field? which need only be worn for 30 mins a day?

pulsed electromagnetic field - induced electric field combined magnetic field - superimposed on a static magnetic field - only needs to be worn for 30 mins a day. *improves compliance*

flank tenderness with dysuria, urgency, frequency in the presence of WBC casts would indicate?

pyelonephritis

patient has large ulcers with purple overhanging edges which rapidly developed from mild trauma/bumps. what is the condition? what is the assoc. condition?

pyoderma gangrenosum ulcerative colitis

a rapidly developing violaceous nodule composed of small blood vessels that bleeds easily, especially associated with ingrown toenails.

pyogenic granuloma

what is the classification system for lisfranc injuries? what is the mechanism of injury of lisfranc fractures/injuries?

quenu and kuss, and hardcastle and meyerson forced dorsiflexion - driver with his foot on the pedal crashes, falls,

how do you diagnose a right bundle branch block on EKG?

rabbit ears on V1,V2V5,V6

how is the diagnosis of congenital vertical talus/convex pes planovalgus/rocker bottom flatfoot made?

radiographically taking a lateral view, and then comparing it with a second view maximally plantarflexed. bisection of the talus matches the tibia talocalcaneal angle is >40 talar neck has an hourglass shape or flat surface

what is the thread to axis angle on a screw? what is the distance between threads on a screw?

rake angle (the angle of the threads compared to the core diameter of the screw) pitch

what is herpes zoster (shingles) of the face and auditory nerve causing facial paralysis and pain?

ramsay hunt

what is the treatment for atrial fibrillation?

rate control: CCBs - verapamil, diltiazem beta blockers, digoxin rhythm control: iv procainamide - first line sotalol amiodarone

a 25 yr old male presents with painful joints, and dermatological lesions on his feet. radiographs show fluffy periostitis. He had a recent venereal infection. what is a possible indication? what is the treatment?

reactive arthritis/ reiters NSAIDs and tetracyclines the skin lesions are keratoderma blennorrhagicum

what structures are released when doing a posterior release for clubfoot? medial release? lateral release?

reflection of abductor hallucis and plantar fascia z plasty of achilles release of ankle and STJ, PTFL and CFL are cut. Z plasty of posterior tibial tendon release of TN joint, spring ligament and knot of henry are cut. release of interosseous talocalc release of bifurcate release of lateral STJ

what type of anesthesia causes the least interference with preexisting diseases?

regional nerve block

synovial fluid analysis reveals pekin cells, what is diagnosed?

reiter syndrome

what syndrome has the triad of arthritis, urethritis, and conjunctivitis?

reiter/reactive arthritis caused by chlamydia often can cause posterior column/vibratory sensation problems.

what is the steps for release for a hammertoe?

release of extensor expansion tenotomy of EDL and EDB transverse MPJ capsulotomy release of collateral ligaments plantar plate release

what is the order of reduction/fixation in calcaneal fractures?

remove the lateral wall blowout. fixate the anterior process fragment to the constant fragment insert a steinmann pin into the posterior tubercle to manipulate it out of varus, and restore length and height by manipulating inferior, medial and valgus. fixate to the constant fragment. pin the lateral articular fragments to the constant fragment lift the posterior facet with an elevator and pin it to the constant fragment transversely. pack any defect/gap in the calcaneus with bone graft (neutral triangle area) replace the lateral wall and then plate and screw everything, starting back at the top.

what medical condition is most likely to contribute to wound failure in a diabetic patient undergoing digital amputation?

renal failure

how are cephalosporins excreted?

renally except for ceftriaxone (both) and cefoperazone (hepatic)

what is the term for "it speaks for itself"?

res ipsa loquitor

what is the order of joint resection and fixation in a triple arthrodesis?

resect the CC, then TN, then STJ temporarily fixate the STJ, then TN, then CC permanently fixate the STJ, then TN, then CC

what is the classification for foreign bodies?

resnick class

pain that occurs when a patient is not active, worse at night, especially when dangling the legs over the edge of the bed.

rest pain - a further progression of arterial occlusion occlusion that is unable to meet even resting muscle demands. if the night pain is relieved by walking it is a venous problem, not arterial.

what are AOs four biomechanical principles for early return of function?

restoration of anatomy stable fracture fixation preservation of blood supply early mobilization of limb and patient

what are the goals of calcaneal fracture fixation?

restore calcaneal height, width, articular reduction, and remove varus.

what is a measure of the percentage of immature RBCs

reticulocyte count percentage normal is 0.5-1.5%

what metatarsal head osteotomy corrects both PASA and the IM angle?

reverdin laird - same as reverdin green (L wedge), but is a through and through osteotomy with translocation for IM correction.

what is the treatment for frostbite? what are the stages?

rewarming in 105/108 deg water for 30 mins with analgesia (meperidine), and possibly antibiotics if more advanced. first degree - superficial without blistering second degree - superficial with clear blistering. third degree - deep freezing with hemorrhagic blisters fourth degree - full thickness with loss of body part.

what are the most common tumor found in the heart?

rhabdomyoma

what is the most common soft tissue sarcoma in children?

rhabdomyosarcoma

what is the most common cause of mitral stenosis? what is the treatment?

rheumatic heart disease treatment is balloon valvuloplasty

what is the organism for rocky mountain spotted fever? what is the clinical picture? how do you treat it?

rickettsia rickettsi maculopapular rash on the palms and soles of the wrists and ankles, spreading centrally. doxycycline

what deformity is the cole procedure performed for?

rigid cavus

what deformity is the dorsiflexory wedge osteotomy of all the metatarsals performed for?

rigid cavus

what deformity is the duvries procedure performed for?

rigid cavus

what deformity is the dwyer procedure performed for?

rigid cavus

what deformity is the jahss procedure performed for?

rigid cavus

what deformity is the japas procedure performed for?

rigid cavus

what procedure is the mcelvenny-caldwell procedure performed for?

rigid cavus

what is the hallmark of congenital vertical talus/convex pes planovalgus/rocker bottom flatfoot?

rigidity

in an external fixator the half pins provide.....? while the tension wires provide.....?

rigidity stability should be 90 deg. to eachother

what is the most common complication of correcting a clubfoot deformity by serial casting?

rocker bottom deformity

overzealous correction of the equinus component of clubfoot can result in?

rocker bottom foot

what procedure performed for frontal plane flatfoot deformity is an opening wedge of the sustentaculum tali with bone graft.

selakovich

which procedure for frontal plane flatfoot limits the abnormal STJ motion?

selakovich

What screw has a fluted tip?

self tapping

what are the aspects of a stent dressing used for skin grafts?

semipermeable non adherent dressing (adaptic, owens silk) several layers of moist saline soaked gauze fluffs tie over sutures

if you see an aneurysmal bone cyst in a person older than 20 what is the appropriate next step?

send to oncology since if its over 20 its highly likely it will be associated with a malignant bone tumor

sensory nerves are afferent or efferent? motor nerves are afferent or efferent?

sensory afferent - ganglia in the dorsal root ganglia outside the CNS. motor afferent - ganglia in ventral/anterior horn in the CNS

in entrapment neuropathy do sensory, motor, or autonomic dysfunctions occur first?

sensory then autonomic and finally motor.

a synovial joint fluid analysis that reveals opaque, white colored fluid that has glucose levels greater than 50mg/dl, more than 75 PMNs, more than 100k WBC, and a variable viscosity would indicate what?

septic

what is a piece of dead bone floating in pus/inflammation? what is a sheath of bone surrounding pus/inflammation? what is a tract through the sheath of bone? what is a chronic abscess in bone surrounded by sclerosis?

sequestrum Involucrum Cloaca brodie's abscess - sign of subacute OM

what is the confirmatory test for acromegaly?

serum GH levels with oral glucose tolerance test

what is the best initial diagnostic test for acromegaly?

serum IGF-1

myxedema coma is due to hyper or hypothyroidism?

severe hypothyroidism - treat with IV T3 of T4

what orthotic distributes weight more evenly for a cavus foot?

shaffer plate

what attaches periosteum to bone?

sharpey fibers

what is the mechanism of injury for salter harris type I and type II? for type III and type IV? how do you fixate salter harris fractures?

shear force bending and compression no screws - use smooth k wires or steinman pins.

what is a condition related to severe postpartum hemorrhage, and the inability to lactate days to weeks after delivery

sheehan syndrome

what is a fx of the posterolateral talar process? what is a fx of the posteromedial talar process? what is a lateral process of the talus fracture?

shepherd's fx/steida process fx cedell's fx snowboarder's fx - V sign on xray

low TSH, a low serum T3, with an increased reverse T3 would lead to?

sick euthyroid syndrome -

a mutation on the beta chain gene resulting in a change of amino acid 6 would indicate?

sickle cell - hemoglobin S

what type of anemia is diagnosed by smear showing pappenheimer bodies? what type of anemia is that?

sideroblastic anemia microcytic hypochromic

a WBC that uses gallium has uptake by what two molecules?

siderophore complex and lactoferrin

what procedure is basically a medial bumpectomy?

silver

what procedure performed for frontal plane flatfoot deformity is a lateral opening wedge osteotomy with graft?

silver

what is the treatment of scabies?

single dose PO ivermectin or 5% permethrin cream covering the entire body from neck down for 12 hours

would sinus tarsitis or sinus tarsi syndrome have pain with eversion of the STJ? would sinus tarsitis or sinus tarsi syndrome have pain with inversion of the STJ?

sinus tarsitis sinus tarsi syndrome

patient with a history of dry eyes, parotid gland enlargement, lack of spit in her mouth, and many dental caries would have what? what is the most common complication of this disease? what is the best initial test?

sjogren's - anti Ro and anti La - antibodies against salivary and lacrimal glands - will see rose bengal stain. lymphoma schirmer's test

when performing a triple arthrodesis, sliding the calcaneus posteriorly before fusion will raise or lower the arch?

sliding posteriorly will raise the arch - increases plantarflexion of forefoot on rearfoot - raising the arch. sliding anteriorly will lower the arch - decreases plantarflexion of the forefoot on the rearfoot - lowering the arch.

periosteal buttressing would indicate a slow growing or rapid growing tumor?

slow growing its just a thickening of the periosteum

what provides the majority of venous drainage to the heel?

small saphenous vein

what is the classification system for talar body fractures?

sneppen type I - osteochondral fx type II - A sagittal, B coronal, C transverse shear force fx. type III - posterior tubercle fx type IV - lateral process fx type V - crush fx

what is the antidote for cyanide overdose?

sodium nitrite, thiosulfate

are hard or soft xrays more dangerous to the patient?

soft xrays - have lower kVp and are more dangerous and result in higher radiation exposure.

in contact period what muscle decelerates the forward movement of the tibia?

soleus

what is the force of the soleus muscle on the subtalar joint during midstance.

soleus creates supinator force on the STJ (its insertion is medial to the STJ), which locks the lateral column and improves function of the peroneus longus.

what is the most common cause of tarsal tunnel?

space occupying lesions - varicose veins. trauma

what is the most common movement disorder and has the most predictable surgical outcome? what are the other types of movement disorders?

spastic - 60-80% nad most favorable prognosis the others are: dyskinetic - 10-25% mixed - 10-25% ataxic - 2-5%

what type of gait has internal rotation and adduction of the entire limb with flexion of the hip,knee, and ankle. what type diseases is this gait seen in?

spastic gait CP, spastic diplegia, paraplegia, hemiplegia

a large percentage of calcaneal fractures are associated with what other injury?

spinal fractures between T12 and L1 take lumbar radiographs before surgery if back pain is present.

what can be used to treat periodic paralysis? what causes periodic paralysis? how is it diagnosed?

spironolactone, or acetazolamide prophylaxis. autosomal dominant hypokalemic states from exercise or high carb diets. diagnosed through the long exercise test (type of EMG)

if a k wire is used to hold a fragment or fixate a fragment what form of fixation does that k wire provide?

splintage - stability but no compression

meshing of autografts is performed on split thickness or full thickness skin grafts?

split thickness/ partial thickness

what is the most common pathogen of a fungal arthritis?

sporothrix schenckii

an infection that presents by way of a puncture wound that develops lesions along the lymphatics.

sporotrichosis - sporothrix schenkii

what ligament attaches to the anterior portion of the sustentaculum tali? what ligament attaches to the posterior to the posterior trochlea of the calcaneus? what ligament attaches to the medial surface of the sustentaculum tali?

spring ligament (two parts; inferior calcaneonavicular and the superomedial portions) calcaneofibular ligament calcaneotibial ligament

between basal cell and squamous cell, which is more aggressive? which is found on the lower lip, which is on the upper lip?

squamous cell SCC - lower lip BSC - upper lip

What skin cancer may appear cauliflower-like?

squamous cell carcinoma

stable angina would have fixed stenosis or transient clotting of atherosclerotic coronary arteries? unstable angina

stable angina has fixed stenosis unstable angina has transient clotting

stable or unstable angina has precordial pain with a predictable amount of exertion?

stable has precordial pain with predictable exertion and pain, relieved with predictable amount of nitroglycerin unstable angina is more severe with greater frequency and requires more time and nitro for relief.

what is the treatment recommendations for under the cierny-mader class?

stage 1 - 2 weeks IV Abx, and 2-4 weeks PO Abx. stage 2 - surgical debridement and 2 weeks IV Abx. stage 3&4 - surgical debridement and 4-6 weeks IV abx.

what are the stages of anderson MRI class of osteochondral lesions of the talus?

stage I - bone marrow edema stage IIa - subchondral cyst stage IIb - incomplete separation of the osteochondral fragment stage III - fluid around an undetached, undisplaced osteochondral fragment stage IV - displaced osteochondral fragment

what are the treatment recommendations based on the stage of johnson and strom?

stage I - tendon debridement, conservative. stage II - tendon transfer, rearfoot arthrodesis stage III - rearfoot arthrodesis, triple arthrodesis stage IV - TCC arthrodesis, pan-talar arthrodesis.

if you have a cellulitis that is blanchable, it is staph or strep? if its non blanching is it staph or strep?

staph aureus strep - deeper and therefore non blanchable.

if a diabetic is planned for surgery and has not taken their long term dose of insulin, or their metformin meds that morning in preparation for surgery, and the surgery is delayed for a couple hours, what should be done to avoid the patient going into hypoglycemia?

start IV D5W NIDDM patients do not take their meds day of surgery IDDM patients take half their dose that morning.

why do steroids cause AVN?

steroids cause fat cells to swell. this causes internal compression outward which causes osteopenia and even AVN.

what is the treatment for cocaine overdose?

supportive control agitation with benzos alpha blockers or combined alpha/beta blockers can be used for HTN. don't use pure beta blockers.

clawing of the toes after calcaneal fracture?

suspicious of compartment syndrome - referred to as volkmann's contracture

what is a silicon toe implant with a U shaped hinge with grommets?

swanson flexible toe implant - wright grommets are only available for sizes 0-5, and are used to protect the implant from shear forces and sharp bone edges they also have lesser MPJ and IPJ implant availability

when testing for small nerve fiber neuropathy, which test is more sensitive? what is the best site for testing?

sweat gland nerve fiber density test - more sensitive than epidermal nerve fiber density test. best site for biopsy is 10 cm proximal to the lateral malleolus - tests C fibers

what total matrixectomy involves removal of the distal half of the distal phalanx?

syme/lapidus

patient with pain to the posterolateral ankle, that gets worse when he squats, or goes down stairs, but without any history of trauma. Active plantarflexion or dorsiflexion of the hallux reproduces the pain.

symptomatic os trigonum movement of the flexor hallucis longus which passes over the ossicle.

which ligament is affected in a weber type C fracture?

syndesmotic ligament/interosseous ligament

between ligaments, joint capsules, and synovial membranes, which has the least nerve supply?

synovial membrane

the innocent murmurs are normally systolic or diastolic?

systolic diastolic are pathologic

50% of heart failure cases are systolic, 50% diastolic. which has dilated ventricles? which has a low ejection fraction of less than 50%?

systolic heart failure has dilated left ventricle and low ejection fraction <50% diastolic heart failure has normal sized left ventricle and ejection fraction >50%

what is the classification for stages of callus development?

tajanas stages colloidal 0-2 weeks - formation of microreticular network fibrillar 2 weeks - 1 month collagen organization lamellar 1 mo - years - formation of compact lamellar tissue and calcification

how are ABIs calculated?

take the pressure in both the arms, always use the higher pressure for both calculations. take the pressure in both the PT and DP pulses in the ankle, and use the higher pressure as the numerator, and the higher of either arm as the denominator. repeat for the other leg using again the higher of either arm as the denominator.

what angle is a line drawn parallel to the tibial plafond and a second line drawn connecting the tips of the medial and lateral malleoli? what is the normal value?

talocrural angle normal is 83

only bone without any muscle origin or tendon insertion?

talus

what type of needle is best for fragile tendon, sheath, muscle or paratenon?

tapered

what is the most common cause of peroneal spastic flatfoot?

tarsal coalition a peroneal block may be required to relax the muscle and evaluate STJ ROM.

what type of external fixator allows for reduction of triplanar complex deformities?

taylor spatial frames

what is the hardest material in the human body?

teeth enamel

what is the anchovy procedure?

tendon interposition used in arthroplasties. you roll up a tendon graft and and insert it into a resected/damaged joint. can suture or k wire the anchovy in place

rerouting a muscle tendon without detaching it from its insertion is called?

tendon transposition

what is the major difference between tendinitis and tendinosis besides acute/chronic and inflammation/degeneration?

tendonitis - type I collagen tendinosis - type III collagen

what kind of anchor is used to attach tendon to bone?

tenodesis screw or interference screw - same thing

K wires can provide compression with what method?

tension band wiring

what type of headache has a band or vice like pain across the head? what is it treated with? what type of headache has recurrent persistent occurrence with a stabbing periorbital pain? what is the treatment

tension headache - NSAIDs cluster headache - 100% oxygen

in external fixators are tension wires or half pins stronger?

tension wires - 1.5-2x stronger due to tensioning

what disease results in a punched out lesion called a gumma? what test can confirm?

tertiary syphilis - treponema pallidum VDRL and RPR 25% of patients will have neurosyphilis

what radionuclide dye is useful for identifying foot perfusion?

thalluim 201

with an ABI of 1.4, which of the noninvasive vascular studies will be accurate?

the TBI and the PVR because they are not affected by non compressible vessels.

what determines the thickness of a cut with a power saw/sagittal saw?

the angulation of the teeth, NOT the thickness of the blade

in a comminuted fracture fixed by a static locked IM nail, what is the working length of the nail? in a non comminuted fracture?

the distance between the proximal and distal locking screws. the portion that spans the fracture site in the proximal and distal fragments.

necrotic muscle fails to display what four signs?

the four Cs contractility capillary bleeding color consistency/firm

when performing a 5th digit derotational arthroplasty, what determines the transverse plane correction? the frontal plane correction?

the more oblique the incision the more longitudinal the incision

when determining which digit to remove in polydactyly, which do you remove?

the most peripheral digit

how do you calculate the post neonatal, and neonatal mortality rate?

the neonatal mortality rate is the number of deaths <28 days old, divided by the live births. the post neonatal mortality rate is the number of deaths from ages 28 days to 365 days divided by the live births.

one step is defined as? one stride is defined as?

the period from heel contact of one limb to heel contact of the other limb one stride is two steps

are the dorsal or plantar lisfranc ligaments stronger? therefore are dorsal or plantar lisfranc dislocations more common?

the plantar ligaments are stronger than the dorsal, so dorsal dislocations are more common.

what is the most commonly used test of mechanical properties of a material?

the tensile test

what are the only FDA approved drugs for treating diabetic foot infections?

the three Zs zosyn zyvox invanz

what is the time it takes for protons to realign with the static magnetic field, also called B0?

the time constant called T1

in regards to MRI, what is the time constant T2?

the time it takes for transverse magnetization to decay over time.

where in the skin do you find langerhan cells? what is their purpose? where do you find melanocytes?

they are found through the epidermis, especially stratum spinosum they are dendritic cells that are involved with the immune system. melanocytes are in the basal cells

what is the drug of choice for cutaneous larva migrans/creeping eruption from parasitic infections?

thiabendazole

what type of oral diabetic medication works by increasing peripheral response to insulin?

thiazolidinediones - rosaglitazone/avandia, and pioglitazone/actos

should a thigh or ankle tourniquet be allowed to remain on the leg longer? does the thigh or ankle result is more neurovascular damage? what is the setting for each?

thigh - ankle has less adipose tissue and should remain on less time. ankle - due to less adipose tissue there is greater risk to neurovascular tissues. 100 over systolic for ankle 200 over systolic for thigh

what type of EKG cardiac rhythm shows no correlation between Ps and QRS complexes?

third degree heart block

what procedure for the correction of metatarsus adductus is a resection of the abductor hallucis muscle?

thompson procedure

best procedure for underlapping 5th toe? for cock up 5th toe? best procedure for overlapping 5th toe?

thompson procedure ruiz mora procedure lapidus

what are some of the tests for achilles tendon rupture?

thompson test - squeeze jack's/hubschers test - passively dorsiflex hallux to active windlass mattles test simmonds test toygar's skin angles - line straight down achilles should be straight, with ATR its not.

what is a disease characterize by inflammatory changes to small to medium arteries and veins caused by hypersensitivity to tobacco?

thromboangiitis obliterans (buergers disease)

what is a palpable linear indurated cord like vessel with pain, tenderness, erythema and warmth to the area?

thrombophlebitis

what is inflammation of a superficial vein that presents as a palpable linear indurated cord? what is the treatment?

thrombophlebitis of the superficial veins self limiting and lasts 1-2 weeks, local heat, best rest, nsaids.

what disorder is due to a defect in the ADAMTS13 gene?

thrombotic thrombocytopenic purpura and hemolytic uremic syndrome TTP and HUS daily plasma exchange

what tendon transfer is usually performed in a chopart amputation? why?

tib anterior is reattached to the neck of the talus to prevent equinovarus and achilles tenotomy to prevent equinus

what is the STATT procedure? what are its indications?

tib anterior is split from its insertion on the base of the 1st metatarsal up proximal to the superior extensor retinaculum and the lateral fibers are passed through the peroneus tertius sheath and sutured to the cuboid. flexible rearfoot varus, talipes equinovarus (clubfoot), excessive supination, dorsiflexory weakness.

what is the most common cause of compartment syndrome in the lower extremity? what compartment is involved?

tibial fractures - the leg is much more common than the foot. anterior compartment is most commonly affected. in the foot lisfranc and chopart's injuries are most likely to cause compartment syndrome.

removal of which sesamoid results in hallux valgus? removal of which sesamoid results in hallux varus?

tibial sesamoid fibular sesamoid

what nerves are blocked in an ankle block? what nerves are blocked in a hallux block? what nerves are blocked in a mayo block?

tibial, saphenous, deep and superficial peroneal, sural. 1st dorsal digital nerve, deep peroneal, 1st plantar digital nerve, 2nd plantar digital nerve. saphenous, deep peroneal, medial dorsal cutaneous, medial plantar

what muscles cause supination of the longitudinal axis of the midtarsal joint? what muscles cause pronation of the oblique axis of the midtarsal joint?

tibialis anterior peroneus longus and GRF

what is the TATT procedure? what are its indications?

tibialis anterior is transferred in entirety to the 3rd cuneiform. indications are drop foot, recurrent clubfoot, flexible forefoot equinus

Timentin what is the dose? what is the indication? what is the spectrum of activity? does it cover pseudomonas?

ticarcillin/clavulonic acid 3.1 g IV q4-6h broad spectrum for polymicrobial infx staph, strep, gram negs, anaerobes yes watch for increased sodium load.

what test is used for viral diseases? what stain is used?

tzanck test - scraping of a fluid and base of a vesicle/bullae. mixed with methanol and stained with wright stain - the presence of multinucleated giant cells suggests herpes

what is the most frequent complication of a patient placed supine in the OR? in the prone position?

ulnar nerve neuropathy pressure on the orbit and dorsum of the foot

what type of bone stimulator causes micromotion at the fracture site?

ultrasound bone stimulator

when working up a cavus foot, what are the aspects you need to identify before you can decide on any treatment? how would you decide between each variable?

underlying etiology (spastic vs progressive vs. stable) - obtained through PMH, DTRs, EMGs forefoot vs rearfoot driven: coleman block test. plane of deformity - radiographically determined rigid vs. flexible - coleman block test

what are the principles of treating a cavus foot based on each variable??

underlying etiology - spastic/progressive conditions are treated with osteotomies and arthrodesis. stable are treated with soft tissue and osteotomies. forefoot drive are treated with manipulation of bones and soft tissues. rearfoot driven are treated with rearfoot osteotomies and arthrodesis. plane of deformity - procedures chosen based on plane of deformity. rigid - osteotomies and arthrodesis flexible - soft tissue and tendon transfers.

what type of bar has ball and socket joints to allow for varus positioning to prevent STJ and MTJ subluxation?

unibar

what bone tumor is has the pathologic fallen fragment sign?

unicameral bone cyst

Benign, geographic, medullary lesion that is fluid-filled?

unicameral bone cyst fallen fragment sign always in the calcaneus

what is the best treatment of PE?

urokinase - 4400 units/kg IV over 10 mins then 4400 units/kg/hr for 12 hours streptokinase - 1.5 million units IV over 60 mins

what is the time frame for fixation of tibial pilon fractures?

usually wait until swelling has subsided in 2 weeks, but must put the patient in a distraction external fixation frame/bohler-braun frame to maintain the length and help realign the fragments by ligamentotaxis.

what arthroplasty procedure is a resection of 1/2 to 2/3 of the dorsal aspect of the joint, but preserves the intrinsic musculature insertions?

valenti - cut off the dorsal 1/2 to 2/3rds of the proximal phalanx and the metatarsal head at an angle inward - creates a v like gap

when performing a triple arthrodesis, would you want fuse the foot in varus or valgus positioning? how much?

valgus 5 degrees body compensates for valgus position, varus is avoided at all costs which results in lateral column pain and calluses.

what is the drug of choice to increase the threshold of convulsions during operation?

valium

what is the best surgical prophylaxis antibiotic for any implant? what is the best prophylactic antibiotic for bacterial endocarditis? in PCN allergy? in any PCN allergy?

vancomycin - because it kills staph epidermis which is the most common pathogen for implants. 1g IV amoxicillin - 2g IV 30 mins prior and 1g IV 6 hrs after. if PCN allergy use erythromycin. Clinda is the DOC for general PCN allergy prophylaxis 300mg IV 30 mins prior, and 150 mg IV 6 hrs post.

what is the contraindication to doing an arthroscopic ankle fusion?

varus or valgus malalignment greater than 15 deg.

what is the principle that states that adjacent fracture generally improve alignment after reduction of the initial fracture?

vassal's principle if you reduce the most primary met fracture the rest of them will fall into place due to soft tissues connecting them.

a holosystolic murmur with mid systolic peak that is high pitched and harsh would be?

ventricular septal defect

during the contact phase, what causes rapid plantarflexion of the forefoot during heel contact?

vertical force from ground reactive forces

serous, fluid filled, elevated skin lesion <1cm serous, fluid filled, elevated skin lesion >1cm

vesicle bulla

what is the most likely pathogen in water exposure?

vibrio - salt aeromonas - fresh mycobacterium

the majority of otitis media, otitis external, sinusitis and pharyngitis are caused by?

viral infection but if its bacterial its alwys the same three: strep pneumo, H. flu, and moraxella

acute pericarditis is most commonly caused by? what are the signs and symptoms? how do you diagnose it? how do you treat it?

viral infections pleuritic retrosternal chest pain(hurts to breathe in), that is worse when supine, improved with leaning forward. EKG will show diffuse ST elevation elevation across all leads, with PR segment depression. treat with NSAIDS and colchicine - best or one of the two if one is contraindicated. or if all else fails steroids.

what are the three factors described in the formation of a thrombi?

virchow's triad: stasis - heart failure, CHF, MI, obesity, dehydration blood vessel injury - trauma, fracture, IV hypercoagulability - neoplasm, Oral contra, preg, surgery, polycythemia.

patients who are using chronic steroids are at higher risk for delayed wound healing, what can be used to counteract these effects?

vitamin A topically. 1000 Units applied TID to teh open wound bed for 7-10 days.

an autoimmune disease that causes small sharply demarcated depigmented macules/patches caused by destruction of melanocytes.

vitiligo diagnose with wood's lamp biopsy will show absence of melanocytes

patient has menorrhagia, or recurrent nosebleeds and an increased bleeding time and posotive ristocetin cofactor test.

von willebrand disease

what is the most common inherited bleeding disorder? how is it diagnosed? what is the treatment?

von willebrand disease - autosomal dominant ristocetin cofactor test desmopressin. or factor VIII, or cryoprecipitate in emergencies

what are the three methods of bone infection? what classification describes them?

waldvogel class hematogenous - via bloodstream contiguous - adjacent tissue direct inoculation - trauma/surgical

what is the treatment for arterial insufficiency?

walking walk til you get claudication pain, rest for 3 mins, and then walk again. 8 x per day.

which capsulotomies provide both transverse and frontal plane correction?

washington monument - a distal to proximal rectangular block is removed and reapproximated. lenticular - an ellipse of capsule is removed and reapproximated. all others are merely transverse plane correction

what is a head osteotomy that is indicated for hallux limitus?

watermann - DP cut with plantar cortex intact, dorsal wedge watermann green - angled cut to preserve the sesamoids.

what is the most common area for achilles ruptures?

watershed area - zone of avascularity 2-6cm above the achilles insertion

what is the classification scheme for posterior lateral talar process fractures?

watson and Dobas I - normal process II - enlarged posterior lateral process III - non fused os trigonum IV - synchondrosis of the os trigonum to the talus

what is the classification system for navicular fractures, and what are the stages?

watson-jones type I - navicular tuberosity avulsion fx by PT tendon (watch for nutcracker fx) type II - dorsal lip avulsion type III - navicular body A - transverse body, non displaced - 100% successful reduction. B - transverse body, displaced - 67% success C - comminuted - 50% success. type IV - stress fx

what modality can be used as an alternative for serial casting of metatarsus adductus?

wheaton brace has a medial flare to abduct the forefoot can also use an IPOS shoe

what brace allows unilateral treatment of tibial torsion?

wheaton brace system - additional piece above the knee - fixated at 90 deg.

when would the moment arm and the lever arm be the same?

when the lever arm is perpendicular to the action line of the muscle

low serum calcium can cause?

wide QRS complex and vice versa

what disorder is diagnosed by a ceruloplasmin and will see keiser fleicher rings?

wilson's disease - too much copper

what are the stages of post operative fever?

wind - pneumonia, PE, atelectasis - 24 hrs water - UTI, dehydration, constipation - 24-48 hrs wound - surgical site infection - 72 hrs walk - DVT - 3+ days wunder - any drug, antibiotics, heparin. 1 week

what partial matrixectomy involves a longitudinal incision is made through the nail and nail bed then through the skin over the nail matrix and the matrix itself. A second incision is made in the skin at the nail fold, completing an ellipse with the first incision. A wedge of tissue is then removed down to the periosteum. The edges are reapproximated and sutured.

winograd

what test can evaluate the entire small bowel, but only the mucosa? what test evaluates the bowel wall for vascular tumors?

wireless capsule endoscopy CT enterography

what is the standard for ordering preop EKG for elective surgery?

women 50 men 40

the thicker the graft the better/worse it incorporates?

worse

when using a bone autograft, what method of preserving it is best, and which is detrimental?

wrapping the graft in moistened saline sponge is best. immersion in saline solution is detrimental

which great toe hemi implant has optional suture holes for flexor tendon attachments?

wright hemi phalangeal implant - phalangeal implant also trapezoidal shaped to match the phalanx

what is a sudden onset of crops of asymptomatic yellow papules with an erythematous rim that occur on extensor surfaces during periods of hypertriglyceridic periods of uncontrolled diabetics?

xanthoma diabeticorum

how would you determine whether a STJ or ankle joint is the joint in need of fusion?

you can perform an injection in the joint and see what the relief is. you can use a hinged AFO to see if the STJ is problematic. you can use a non hinged AFO to see if the ankle joint is problematic, however you have to do the hinged first.

what head osteotomy incorporates correction for metatarsus elevatus?

youngswick modification of austin

what total matrixectomy involves two incisions from the corners of the eponychium?

zadik

what is a disease of recurrent peptic and duodenal ulcers despite proper H. pylori treatment?

zollinger ellison syndrome - from gastrinoma

what is the weakest point of the physis?

zone of cartilage maturation

what are the stages of university of texas classification of ulcers?

0 - no open lesion 1 - superficial wound 2 - tendon/capsule 3 - bone/joint further classified by A: - no complication B - with infection C - ischemic D - infection and ischemia

what are the classes of wagner's ulcer classification?

0 - pre ulcerative area without open lesion 1 - superficial ulcer (partial thickness) 2 - ulcer deep to tendon, capsule, bone. 3 - stage 2 with abscess, OM, or joint sepsis 4 - localized gangrene 5 - global foot gangrene A - neuropathic B - ischemic C - neuroischemic

what is the normal CRP (C reactive protein)?

0-0.6 mg/dL becomes elevated sooner than ESR (6-8 hours)

What are the lateral ankle ligaments?

Anterior talofibular, calcaneofibular, posterior talofibular

what are the aerobic gram negative cocci?

Neisseria

What are the components of the deltoid ligament?

Superficial - tibionavicular, tibiocalcaneal, posterior tibiotalar Deep - anterior tibiotalar

OM would show what on MRI?

T1 - decreased signal intensity T2 - increased signal intensity Rim sign: thin layer of active infection around normal bone

what drugs can cause a leukocytosis? what drugs can cause a leukopenia?

lithium, corticosteroids methotrexate, dilantin, salicylates

what is labored respirations when they lay flat?

orthopnea

an entire foot burn is equal to about what percentage of the body?

3.5%

how many joints are in the foot?

35

most likely organism in an immunocompromised patient.

gram negs

which inhalation agent is nonflammable?

halothane

the majority of tendon vascularity comes from?

mesotendon

what is the only drug used for treating raynaud's?

nifedipine

would the ESR be elevated or not in AVN?

not elevated

what is the anti inflammatory dose of ibuprofen?

1200-3200mg/day

what are the normal values for sodium? chloride? BUN? glucose? creatinine? CO2? Potassium?

135-146 96-106 10-20 70-110mg/dl 0.6-1.2mg/dl 24-32 3.5-5.0

when performing an ankle medial oblique radiograph, the tube would be angled ______ deg to demonstrate mortise, and ______ to demonstrate bony structure.

15-20 45

splints or braces that have a rigid bar connecting the feet should have a varus/valgus bend?

15-20 varus bend to prevent subluxation of MTJ, and STJ

evidence says that lymphocytes should be over _____ for proper immune function.

1500

the STJ axis is ____ from the sagittal plane, ______ from the transverse plane. Neutral position is? average ROM is? a minimal of ______ deg of ROM is required for normal ambulation.

16 deg, and 42 deg. neutral position is 2/3 the distance from the most supinated position. average ROM is 25-30 deg. minimum of 12 is required.

what is the normal tibial torsion in an adult? normal malleolar position?

18-23 13-18 external

Ivanz what is the dose? what is the spectrum of activity? does it cover MRSA? pseudomonas?

1g IV Q24 Gram positive, Gram negative, and anaerobes NO, and NO

vancomycin what is the dose? what is the indication? what is the spectrum of activity?

1g IV q12h MRSA all gram pos

what is the ideal rate for tension stress influences in external ring fixator lengthening?

1mm/day in 4 increments

Name a couple cephalosporins for each generation

1st Generation - cefazolin (Ancef), cephalexin (Keflex) 2nd Generation - cefaclor (Ceclor), cefuroxime (Ceftin) 3rd Generation - ceftriaxone (Rocephin), ceftazidime (Fortaz), cefdinir (Omnicef) 4th Generation - cefepime (Maxipime)

how do you radiographically diagnose a splayfoot?

1st IM angle >12° 4th IM angle >8° With metatarsus primus adductus, there is a high predilection of splayfoot

what is one of the primary procedures for rheumatoid arthritis in the feet?

1st MPJ fusion with pan met head resections of the lessers - called hoffman clayton procedure

what are the four phases of bone scans, and what does each visualize? which phase specifically is best for OM?

1st phase - blow flow phase 1-3sec - visualizes blood flow to an extremity 2nd phase - blood pooling 5-10min- quantifies relative hyperemia or ischemia 3rd phase - delayed phase/bone imaging phase 3-4hrs - visualize areas of bone metabolism for determining *OM* vs cellulitis. 4th phase - 24 hrs - useful for diagnosis of OM, and shows greater bone than soft tissue activity. If the ratio at 24 hours has increased more than one whole number compared to the 3rd phase. its pos for OM. and if the ratio has decreased more than one whole number compared to the 3rd phase its neg for OM.

what joint is triplanar but not pronatory/supinatory?

1st ray

Periosteal reaction that cannot keep up with tumor growth is termed?

"Codman's Triangle" and is suggestive of an extremely rapid growing malignant lesion

a tibial sesamoid position of _____ or greater indicates crista erosion of the first metatarsal.

4 or greater

how long after a revascularization procedure does it take for optimal blood flow to reach a wound?

4-10 days

What antibiotics are metabolized by the liver?

(3 C's and 1 E) Clindamycin Cefoperazone Chloramphenicol Erythromycin

Name the benign bone tumors of the foot

(FOG MACHINES) F - fibrous dysplasia O - osteochondroma G - giant cell tumor M - myeloma A - aneurysmal bone cyst C - chondroblastoma, chondromyxoid fibroma, clear cell H - hemangioma I - infection N - non-ossifying fibroma E - eosinophillic granuloma, enchondroma, epidermal inclusion cyst S - solitary bone cyst

What medication should be given if the patient is an overproducer? Underexcretor?

(Over-Achieving, Under-Paid) Overproducer → Allopurinol Underexcretor → Probenecid

what are the symptoms of compartment syndrome? which is the most important symptom?

-Pain out of proportion - *most important* -Paresthesia - pins and needles -Pallor - loss of blood flow -Paralysis -Pulselessness - from pressure -Pressure/poikilothermia

what are the minimum degrees needed at the midtarsal joint to maintain the foot plantigrade in contact phase?

4-6 degrees of longitudinal axis motion with the STJ pronated

it is hard for the body to heal bone ends that are farther than _____ apart.

1 cm - or the gap is greater than radius of the bone at that level

how far apart should incisions be placed to avoid skin necrosis?

1 cm apart

what is the daily recommended dietary protein intake for a person trying to heal a wound?

1.5g/kg

what can be used instead of phenol for chemical matrixectomy?

10% sodium hydroxide lavage with acetic acid

What is the lag time for presentation of osteomyelitis on an X-ray?

10-14 days

how long after a new drug does a drug reaction occur?

10-14 days - so the new drug you just administered an hour ago is not the culprit pink morbiliform rash

what are the types of shock?

-Hypovolemic: most common; defined as the acute loss of circulating blood. Treatment is aggressive fluid replacement. -Cardiogenic: induced by myocardial dysfunction. -Neurogenic: secondary to decreased sympathetic tone from head and spinal cord injuries. -Septic: shock secondary to infection.

there are multiple augmentations to a primary achilles repair. what does the lynn entail? the silverskold? Lindholm? the bug and boyd?

-Lynn: Plantaris is fanned out to reinforce -Silverskold: 1 strip of gastroc aponeurosis brought down and twisted 180 degrees -Lindholm: Utilizes multiple strips of gastroc aponeurosis -Bug and Boyd: Strips of fascia lata are used to reinforce

what is the location of the cut for an evans osteotomy?

10-15mm (1.0-1.5cm) posterior to the CC joint

describe eichenholtz classification.

-Stage 0: High risk pre-Charcot -Radiograph: Unremarkable. Stage 1: Acute/Developmental -Radiograph: Capsular distention, fragmentation, debris, subluxation -Clinical: Red, hot, swollen foot with joint laxity Stage 2: Coalescence -Radiograph: Sclerosis, resorption of debris, fusion -Clinical: Subjectively decreased red, hot, swollen Stage 3: Reconstruction -Radiograph: Decreased sclerosis (with increased vascularity) and remodeling -Clinical: Decreased joint mobility with increased stabilization

what is a tillaux chaput fx? wagstaff? volkmann? bosworth? potts? destot? dupuytren?

-Tillaux-Chaput fx: AITFL avulsion from the anterolateral tibia -Wagstaff fx: AITFL avulsion from the anteromedial fibula -Volkmann fx: PITFL avulsion from the posterior-lateral tibia -Bosworth fx: PITFL avulsion from the posterior-medial fibula -Pott's fx: Generic term for a bimalleolar ankle fracture -Destot fx: Generic term of a trimalleolar ankle fracture -Dupuytren fx: At least a bimalleolar fracture when the talus gets lodged up between the tibia and fibula

describe brodsky classification.

-Type 1: Lisfranc joint (27-60% incidence) -Type 2: Chopart's joint and STJ (30-35% incidence) -Type 3A: Ankle joint (9% incidence) -Type 3B: Posterior calcaneus -Type 4: multiple combinations -Type 5: forefoot

what is the normal talar neck angle?

10-20

what is the average cadence of a healthy adult person?

100-125 steps per minute

on EKG paper, one little box 1mm equals how much time? a big 5mm box? you could determine the heart rate by measuring consecutive QRS complexes, how many bpm per big box?

0.04 seconds 0.20 seconds 1 = 300, 2= 150, 3=100, 4=75, 5=60, 6=50 (divide 300/big boxes)

how thick is the epidermis? how long does it take for basement membrane cells to reach the surface?

0.04mm 4 weeks

what is the normal PR interval? if longer? if shorter?

0.12- 0.21 heart block WPF and Lown-Ganong-Levine

what percent of patients undergoing surgery develop DVT?

0.5-3.5%

how thick is the dermis? how does the dermis connect to the epidermis?

0.5mm thick finger like projections called dermal papillae

what are the principles of AO? (arbeitsgemeinschaft fur osteosynthesen fragen)

1 - accurate and precise anatomical reduction of fracture fragments 2 - atraumatic surgical technique and preservation of blood supply 3 - rigid and stable fixation 4 - early mobilization

what muscles are innervated by the medial plantar nerve?

1 LAFF 1st lumbrical Abductor hallucis FDB FHB

what are the structures cut in a lateral release?

1. Extensor hood 2. ADH tendon release 3. Fibular sesamoid ligament 4. Lateral collateral ligament 5. FHB

a CBC will show a shift to the left/immaturity, when the count is elevated above..?

10k

what is the loading dose of warfarin?

10mg or 7.5mg PO q daily adjust to INR of 2.5

what is the optimum compression for bone healing?

12-18 lb per sq in

Aggressive bone tumors require a complete and prompt work-up that includes:

1. Plain radiographs 2. Bone scan 3. MRI 4. CT chest/abdomen 5. Laboratory studies: CBC, electrolytes, LFT's, alkaline phosphatase, and LDH 6. Consultation with a musculoskeletal oncologist

what is the thread pitch for cortical bone? for cancellous bone?

1.25mm 1.75mm

you have ______ before a fracture starts healing, within that time frame you can still take a fracture to the OR for fixation.

2 -3 weeks

what is the time span that lab results are still viable for preparing for surgery?

4-6 months

what grades of gustillo anderson open fractures must be treated with antibiotics?

2 and 3

osteomyelitis can take how long to show up on xray?

2 weeks after about 50% of bone loss.

what is the dosage for morphine? for dilaudid?

2-4 mg IV q2-6h prn mod-severe pain hydromorphone 2-8 mg PO q3-4h prn severe pain 1-4 mg IV q4-6h prn severe pain

In order to raise the potassium by 0.1 how many milliequivalents of potassium do you give?

20 milliequivalents

what is the incidence of bipartite sesamoid? how would you tell a bipartite sesamoid from a fractured sesamoid?

20% compared radiographs to old films, or compare to the contralateral foot since its often bilateral.

What is the half-life of Coumadin? How long before Coumadin is therapeutic?

20-60 hours 3-5 days

what is the normal metatarsal declination angle? normal met length? normal met protrusion?

21 deg 23541, 23145

If a subungual hematoma is present there is what subsequent sequelae? at what percentage of subungual hematoma coverage should the nail be removed?

25% chance of underlying phalanx fracture more than 25% *only 1mm squared of free space from onycholysis is necessary for hematoma development*

what are the doses of ciprofloxacin?

250-750 PO q12h 200-400 IV q12h

what is the size of cerclage wire/monofilament wire?

26-28 ga

in a lisfranc's fracture any displacement greater than ____ between the 1st and 2nd mets requires ORIF.

2mm

what is the normal metatarsal protrusion distance?

2nd met should extend beyond the 1st by 2mm or so

what are the most common sites for stress fractures?

2nd metatarsal and distal tibia/fibula on xray seen at 2-3 weeks MRI 1-2 weeks bone scan scintigraphy - 7 hrs

how many tendons are found within the extensor digitorum brevis?

3 - one for each of the 2nd, 3rd and 4th digits.

what is the dose of clindamycin?

600-900 mg IV q8h or 150-300 mg PO BID

What is the max daily dose of colchicine?

6mg

for any open fracture/gustillo-anderson, antibiotics must be administered within _____, and remain on board for at least ______.

3 hours 72 hours

what is the normal developmental time for a baby to lift its head while prone?

3 months

how long after a first episode of DVT should a patient be treated with long term anticoagulants?

3 months of coumadin with the PT around 1.3-1.5

how long before surgery should patients on anticoagulants stop their meds? when do they resume? what about heart meds eg. beta blockers etc?

3-6 days - if they cannot stop their anticoagulants, stop them 3 days prior and start heparin drip and stop that drip 2-4 hrs prior to surgery. 24 hrs post op continue up to, and including the morning of surgery.

what is the normal value of albumin?

3.6-6g/dL

during the last ______ deg of knee extension in gait the tibia rotates ________. the most rapid rotation occurs during the final ______ deg. of knee extension.

30 deg laterally 5 deg.

How to dose Lovenox for perioperative DVT prophylaxis?

30 mg SC q12h for 7-10 days (adjust dose to q24h for renal patients)

how long before surgery do you give prophylactic antibiotics? when would you give prophylactic antibiotics?

30 mins before incision time. dirty wounds, preexisting valvular heart disease, surgery longer than 2 hrs, blood transfusion, preexisting infx, implants.

what is the number assoc. with vitamin D deficiency?

30 or less

what is the toxic dose of lidocaine 1% plain? lidocaine 1% with epi? bupivacaine 0.25% plain? bupivacaine 0.25% with epi? toxic doses increase or decrease with epi?

300 mg/30ml 500mg/50ml 175mg/70ml 225mg/90ml increase

smokers have what incidence of risk of complications with regards to surgery?

36%

what is the wavelength of the wood's light?

360nm erythrasma can be diagnosed (corynebacterium minitissimum) treated with erythromycin cream

if taking xrays through a wet plaster cast, how much do you increase the mAs? dry plaster cast? wet fiberglass cast? dry fiberglass cast?

3x increase 2x increase 60% increase 40% increase

how many articular facets in the 1st metatarsophalangeal joint/1st MPJ?

4 the first metatarsal head the base of the proximal phalanx one for each sesamoid

how many articulating surfaces of the calcaneus?

4 - 3 superior and 1 distal at the CC joint.

what is the normal ankle arthroscopy scope size?

4.0mm with a 30 deg viewing angle

to qualify for a tendon transfer the muscle must have what strength level?

4/5 or greater because the tendon transfer always loses 1 grade of strength

what angle is used for a calcaneal axial view?

40 deg to the head/cephalic angle

zyvox what is the dose? what is the spectrum of activity? does it cover MRSA? pseudomonas?

400-600 mg PO/IV q12h All Gram positives, including MRSA and VRE MRSA yes, NO What is a major side effect? Thrombocytopenia

every 1mm of lateral displacement of the talus results in _____ decrease in tibiotalar contact.

42% - as described by ramsey and hamilton.

what are the angles that are permissible for a z plasty? angles less than what is permissible result in? angles more than what is permissible result in? what angle gives the greatest lengthening? a Z plasty with the maximum allowable angle results in how much increase in skin lengthening z plasties are most useful in treating?

45-60 impaired blood flow to the flap severe tension 60 deg 60 deg results in 75% increased skin lenth. linear scar contractures

STJ axis of motion

48° from frontal plane 42° from transverse plane 16° from sagittal plane

benign bone tumors outnumber malignant ones to what ratio?

4:1

what is the annual total body radiation dose limit

5 rem/50mSv

what blood glucose level corresponds to the A1c%

5% - 100 mg/dl for every 1 add about 30 6 - 126 7 - 154 8 - 183 9 - 212 10 - 240 11 - 269

what is the occupational radiation dose for skin/extremities? for the lens? the whole body?

50 rem 1 rem 5 rem

How to dose Heparin for perioperative DVT prophylaxis?

5000 units SC 2h prior to surgery 5000 units SC q12h until patient ambulates

for proper nail function and adherence there should be no onycholysis within ______ of the lunula.

5mm

how many angiosomes are there in the foot and ankle?

6 angiosomes fed by the posterior and anterior tibial arteries and the peroneal artery.

what is the golden period for open fracture debridement? what is the golden period for antibiotics for open fractures?

6 hours less than 3 hours, for 72 hours duration - ancef 2g; (for farm accidents use penicillin G 10-20 million units IV daily over q6h)

How long should elective surgery be delayed following an MI or CABG?

6 months

how many possible fracture fragments are there in calcaneal fractures? what is the constant fragment?

6 possible the sustentacular fragment - due to its strong (9) ligamentous attachments it is the part that always remains most stable and all other fragments are fixated to it.

fixation for a triple arthrodesis is usually what?

6.5-7.0 mm screws for the STJ and staples for the CC and TN joints.

what is the amount you tension an external fixator wire to in the foot? in the calcaneus? in the leg on a half ring? in the leg on a full ring?

60 in the foot 90 110 130 in the leg

warts have a spontaneous remission rate of _______.

60%

how many compartments are there in the foot, what are the compartments of the foot, and what is in each one?

9 compartments Intermetatarsal/interosseous Compartments X 4: Contains the interossei muscles -Medial Compartment: Abductor Hallucis, FHB -Lateral Compartment: Abductor digiti minimi, flexor digiti minimi -Superficial Central Compartment: FDB, lumbricals, FDL -Deep Central/Adductor: Adductor Hallucis -Calcaneal Compartment: Quadratus Plantae and PT artery/vein/nerve lateral plantar artery/nerve.

what is the normal developmental time for a baby to sit up?

9 months 6 months is roll over

what is the term for when in an MRI energy is used to align the protons in the z axis to the xy axis and then collecting that pulse energy from its reversal?

90 deg pulse or flip angle

what orientation of a lag screw provides the optimal compression? what orientation provides the most resistance to displacement from axial loading?

90 deg to fracture line 90 deg to the long axis of the bone.

in what position would you want to fuse the ankle joint?

90 deg to the leg, and slight external rotation

what is the absolute/relative skin temperature of the foot?

94 F

what is the normla QRS interval?

<0.12

What should the INR be for elective surgeries? What should be done if the INR is over that range?

<1.4 if more than 1.4 - If necessary, transfuse Fresh Frozen Plasma (FFP) One unit of FFP will decrease INR by approximately 0.2

how would you differentiate between gustillo-anderson types?

<1cm - type I 1-5cm - type II >5cm - type III IIIA: Adequate soft tissue coverage IIIB: Extensive soft tissue damage with periosteal stripping and massive contamination IIIC: Arterial damage requiring primary repair

what toe brachial index/TBI is associated with healing in diabetics? specifically on the digits?

>55mmhg healing >45-55mmhg uncertainty <45mmhg no healing at least 30 mmhg is required for healing wounds on the digits themselves.

How large must a glass foreign body be to be visible on plain film radiography?

A piece of glass, regardless of whether it is leaden, must be >5mm to be visible.

What direction should transsyndesmotic screws be inserted?

Approximately 30° from the sagittal plane from posterior-lateral to anterior-medial

when a lesion marker is placed on the skin when taking a radiograph, what are the only views that should be taken?

AP and Lateral

what lab results are not a positive predictor of hepatic mortality preoperatively?

AST/ALT ascites, bilirubin, albumin, INR are all positive predictors for hepatic mortality.

in regards to ASTs and ALTs, which is more specific for cardiac necrosis, and which is more specific or liver necrosis?

AST/SGOT for cardiac - S for stroke ALT/SGPT for liver - L for liver

if a person has a positive anterior drawer of the ankle on radiographs, and a positive peroneal tenogram, what can be assumed?

ATFL and CFL rupture ATFL - anterior drawer - 10mm of anterior displacement. CFL - peroneal tenogram extravasation

what are the lateral ankle ligaments? syndesmotic ligaments? what are the medial ankle ligaments?

ATFL, CFL, PTFL AITFL, PITFL, IOTTFL, interosseous ligament. superficial: tibionavicular, tibiocalcaneal, PTTL deep: ATTL, PTTL.

what is the MRI classification of osteochondral lesions of the talus?

Anderson classification

What conditions are associated with positive HLA-B27?

Ankylosing spondylitis Reiter disease psoriatic arthritis reactive arthritis Ulcerative Colitis

What are some effects of steroids?

Anti-inflammatory Decreases production of prostaglandins, cytokines, and interleukins Decreases proliferation and migration of lymphocytes and macrophages Metabolic Decreases osteoblast activity

Following a transfusion of PRBC, when will changes in the H/H be seen?

Approximately 3 hours. Therefore, order new labs to be drawn 4 hours after last unit given.

what are the ABCDs of melanomas?

Asymmetry Border Color Diameter

What are the stages of avascular necrosis?

Avascular - loss of blood supply, epiphyseal growth ceases Revascularization - infiltration of new blood vessels, new bone deposited on dead bone, flattening or fragmentation of articular surface Repair and remodeling - bone deposition replaces bone resorption Residual deformity - restoration of epiphysis, sclerosis, deformed articular surface

in a patient with suspected meningitis, what is the most sensitive test? what is the most accurate test?

CSF protein CSF culture always start antibiotics before doing any tests (Lumbar puncture) or sending for CT scan.

what is the gold standard for diagnosing subtalar coalitions?

CT

what is the gold standard for diagnosing tarsal coalitions?

CT, followed by radiographs

What 5 types of fractures is it mandatory to get a CT scan with?

Calcaneal-Sanders Lis Franc- hardcastle/meyerson Talus- Hawkins (neck), Sneppen (body) Pilon Tri-planar-Salter Harris

what disease has a positive leukocyte alkaline phosphatase test?

CML - chronic myeloid leukemia will be decreased in disease

radiographs that show anteater sign would indicate?

CN bar

which coalition of the rearfoot is most symptomatic? asymptomatic?

CN bar TN

weakly positively birefringent crystals when parallel to light. negatively birefringent crystals when parallel to the light.

CPPD blue crystals - large joints (ankle, knee wrist) - assoc. with *hyperparathyroidism* and hemachromatosis. - chondrocalcinosis Gout - yellow crystals

what is a progressive disease of the sympathetic nervous system that is characterized by persistent, burning pain, sensitive skin, and non responding to NSAIDs? what is the treatment?

CRPS - usually due to prior injury sympathetic block and surgical sympathectomy

What are the bone tumors typically located in the epiphysis? metaphysis? diaphysis? centrally located? eccentrically located/medullary? cortical? periosteal?

Chondroblastoma, Giant cell tumor (forms in metaphysis) Enchondroma (also diaphyseal), Osteochondroma, Nonossifying fibroma, Unicameral bone cyst, Aneurysmal bone cyst, Giant cell tumor (extends into epiphysis), Medullary osteosarcoma, Periosteal osteosarcoma, Chondrosarcoma Osteoid osteoma, Osteoblastoma, Enchondroma (also metaphyseal), Ewings sarcoma, Periosteal osteosarcoma, ossifying fibroma Enchondroma, Unicameral bone cyst Giant cell tumor, Chondrosarcoma, Osteosarcoma Osteoid osteoma, Nonossifying fibroma Osteochondroma, Periosteal osteosarcoma

Name the malignant bone tumors of the foot

Chondrosarcoma Osteosarcoma Periosteal sarcoma Ewings sarcoma Fibrosarcoma Multiple myeloma

What is the ASA classification for general anesthesia?

Class 1 - healthy Class 2 - mild systemic disease Class 3 - severe systemic disease Class 4 - incapacitating systemic disease that is a threat to life Class 5 - moribund patient who is not expected to live without surgery Emergency

what antibiotics are metabolized by the liver?

Clindamycin cefoperazone chloramphenicol erythromycin

When should a foreign body be removed?

Clinical signs of infection, known contaminated object, pain, object close to NV elements, intra-articular

what is the most common bacteria causing soft tissue emphysema?

Clostridium perfringens

What are characteristics of a chondrosarcoma?

Common, malignant, moth-eaten, lesion with medullary and soft tissue calcifications - the key diagnostic sign is the so-called "smoke ring calcification" within the tumor May arise from malignant transformation of enchondromas or osteochondromas 5th to 6th decades of life Painful

What are characteristics of a Ewings sarcoma?

Common, malignant, primary bone tumor Aggressive, permeative, lytic lesion with hair-on-end, Codman triangle, and onion skin (wings and onion rings) May have large soft tissue mass Usually under 20 y/o Painful with fever, weight loss, and elevated ESR Poor prognosis

What is the most common time for post-operative myocardial infarction?

Day 3

closed reduction of lateral subtalar dislocations may be prevented by interposition of?

FDL tendon and tib posterior tendon

what is the CT classification of osteochondral lesions of the talus?

Ferkel and sgaglione

what are the criteria for SIRS?

Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F) Heart rate of more than 90 bpm Respiratory rate of more than 20 breaths per minute Abnormal white blood cell count (>12,000/µL or < 4,000/µL or >10% immature/band forms) Sepsis is 2 or more with a source of infection.

what are the most common risk factors for peptic ulcer disease?

H. pylori infection and NSAIDs

what is the purpose of lag technique? is it compression or lack of motion that is osteogenic?

Generates compression. So? Compression leads to lack of motion and therefore primary bone healing. Motion disrupts angiogenesis, decreases oxygen tension levels and inhibits osteogenesis. So, it is the lack of motion and NOT the compression that is osteogenic.

what are the doses of the major aminoglycosides? what is the spectrum of activity?

Gent and Tobramycin 3-5 mg/kg q8h Amikacin 15 mg/kg q8h Gram negative aerobes

what are the different patterns of bone destruction?

Geographic - well-defined, short zone of transition → benign or low-grade malignancy a. Unicameral bone cyst b. Enchondroma Moth-eaten - more aggressive, intermediate zone of transition → benign or malignant a. Giant cell tumor b. Eosinophilic granuloma Permeative - poorly-defined, wide zone of transition → malignant a. Ewing's sarcoma

What primary bone tumors are more frequent in females?

Giant cell tumor ABC Parosteal osteosarcoma

What are characteristics of an osteoblastoma?

Giant osteoid osteoma Benign tumor that may become malignant Osteolytic lesion with well-circumscribed nidus (>1.5 cm) that may have multiple calcifications, and cortical thinning. 2nd to 3rd decades of life Less symptomatic than osteoid osteoma, pain not relieved by ASA

What is pannus?

Granulation tissue that secretes chondrolytic enzymes which break down articular cartilage

What level of the body is a Greenfield filter inserted?

Inferior vena cava below the renal veins

what total ankle replacement hardware is interchangeable with the inbone II's tibial component?

Infinity total ankle system the talar component can be interchanged, and is more of a resurfacing implant vs the inbone II talar component.

What is an early radiographic finding of bone graft healing?

Initial radiolucency of the graft due to increased osteoclastic activity which is followed by osteoblasts laying down new bone

What is pes anserinus?

Insertion of sartorius, gracilis, and semitendinosus on the medial tibia

what pathway does heparin work on? what pathway does Coumadin/warfarin work on?

Intrinsic pathway - PITT Potentiates antithrombin III 100-fold, which inhibits the serine protease in the clotting cascade Extrinsic pathway - PET Interferes with clotting factors II, VII, IX, X

What are causes of microcytic, hypochromic anemia?

Iron deficiency, thalassemias, anemia of chronic disease, sideroblastic anemia, lead poisoning.

what procedure is a medial bumpectomy but with an adductor tendon transfer and fibular sesamoid excision?

McBride

what procedure for the correction of cavus foot is a is a dorsiflexory fusion of the 1st met cuneiform joint?

McElvenny-Caldwell

what arthrodesis procedure is a fusion of the 1st MPJ by spearing the head of the prepared metatarsal into the base of the proximal phalanx?

McKeever

what procedure performed for sagittal plane flatfoot is a plantar wedge of both the navicular-1st cuneiform, and the 1st cuneiform - 1st metatarsal with fusion of those joints?

Miller

What are signs of hypoglycemia? What are signs of hyperglycemia?

Nervousness, tachycardia, diaphoresis, nausea, headache, confusion, tremor, seizures, coma Polyuria, polydipsia, weight loss

Talar declination angle Talo-navicular joint Calcaneal inclination angle Kite angle (Talocalcaneal) - AP view Talocalcaneal angle - Lateral view

Normal 21° Pronation - increases Supination - decreases Normal 75° coverage Pronation - decreases coverage Supination - increases coverage Normal 21° Pronation - decreases Supination - increases Adult 20-40° Pronation - increases Supination - decreases Normal 25-50° pronation - increases supination - decreases

Metatarsus adductus angle Metatarsal abductus angle 1st Metatarsal-medial cuneiform angle 1st ray ROM Metatarsal declination angle IM angle of 1st and 2nd metatarsals IM angle 4th and 5th metatarsals

Normal <15°, pathlogic >20 normal 0-15 Normal 22° Normal 5 mm dorsiflexion + 5 mm plantarflexion = 1 cm total ROM normal 21 normal 8-12, base wedge indicated in >15 Normal 7° Pathologic >9°

what are the available bioabsorbable materials used? which absorbs faster?

PGA (PGA, PLGA) - absorbs fastest PLA (PLA, PLLA, PLDLA, PLDLLA)

what are some surgical procedures for flexible pes cavus? for rigid pes cavus?

Soft Tissue for flexible Jones tendon transfer Hibbs tendon transfer STATT peroneus longus anastomosis limits plantarflexion of the 1st ray, and increases eversion forces. posterior tibial and peroneus longus tendons cut and attached to the calcaneus. steindler stripping plantar fascial release osseous for rigid cole japas duvries dwyer mcelvenny/caldwell DFWO of all mets jahss

white superficial onychomycosis is caused by? all other types of onychomycosis are usually caused by?

T. mentagrophytes T. rubrum

does T1 or T2 image measure the time for the axial spin to return to its resting state?

T2

when deciding to use a TNF inhibitor, what test would you perform on the patient first?

TB test (PPD or quantiferon) because these drugs can trigger a TB infection.

radiographs show a halo sign or C sign, what is indicated?

TC coalition

which of the non invasive vascular studies is used to evaluate if HBO (hyperbaric oxygen) therapy will be useful? what is the level at which HBO is considered needed?

TCOM If the TCOM reading is less than 30 to 40, the patient has a problem involving oxygen transport that is serious enough to consider hyperbaric oxygen therapy. If hyperbaric therapy is going to help the patient, the TCOMs should rise from 30 to 40 to over 200.

what are the doses of bactrim?

TMP 80/SMX 400 TMP 160/SMX 800

an absence of the dorsal aspect of the cyma line on radiographs would indicate?

TN coalition

of the three joints fused in a triple arthrodesis, which joint requires the longest time for revascularization?

TN joint

what biomarker is found increasingly within the synovium of HLA B27 and RA diseases?

TNF

how is hypothyroidism diagnosed? how is hyperthyroidism diagnosed?

TSH high, free T4 low TSH low, free T4 high, high radioactive iodine uptake and antimicrosomal and antithyroglobulin antibodies.

what is the best initial test for endocarditis?

TTE - transthoracic echocardiogram if that is not diagnostic get the transesophageal echo - TEE which is more sensitive

what is used to assess the natural history of valvulopathies and follow them for the optimal timing of valve replacement?

TTE - transthoracic echocardiography

what type of radio dye is useful when used in conjunction with bone scans to assess capillary bed perfusion in diabetics?

Tc-99MMA (macroaggregated albumin)

in a HAV deformity, what does the position of the tibial sesamoid indicate?

The tibial sesamoid indicates the abnormal affects of the adductor and flexor brevis tendons

First choice for non-narcotic IV?

Toradol 30-60 mg IV

which types of local anesthetics have a higher risk of systemic toxicity?

amides - because they are broken down in the liver, which takes longer and so a higher risk of toxicity when it accumulates. lidocaine, marcaine etc.

ketamine has what effects?

amnesia only

what nerve innervates the extensor digitorum brevis?

deep peroneal nerve

patients with sulfa allergies must avoid what antibiotic?

bactrim

what are the Oral MRSA antibiotics? what are the IV MRSA antibiotics? what are the topical MRSA antibiotics?

bactrim clindamycin linezolid/zyvox bactrim clindamycin synercid cubicin vancomycin bactroban

what procedure is a resection of the CN bar?

bagley procedure cowell procedure - resection with EDB muscle belly insertion into the gap.

extra-articular coalition that occurs outside the normal joint intra-articular coalition that occurs at a normal joint site

bar bridge

patient presents with altered mental status, respiratory and CNS depression, with loss of reflexes. what drug overdose? how do you treat it?

barbiturates supportive alkalinize urine with bicarbonate

what is the classification scheme for talar dome lesions/OCDs of the talus?

berndt and harty - osteochondritis dissecans. stage I - subchondral impaction with intact cartilage stage II - partly detached osteochondral fragment stage III - completely detached, non displaced osteochondral fragment stage IV - displaced osteochondral fragment

peripheral nerve fibers are divided into A, B, and C. the A nerve fibers are further divided into alpha, beta, gamma, delta. which are responsible for transmitting pain and temperature? which are for proprioception? which are for motor function? which are for light touch/pain?

beta gamma alpha delta

bacterial meningitis in a neonate is most likely caused by? in an adolescent with rash? in an adult? in immunocompromised people? whats the treatment for each?

beta hemolytic group B strep - ampicillin + gentimicin, after 7 days add cefotaxime. neisseria meningitis - IV ceftriaxone and vanc strep pneumo - IV ceftriaxone with vanc and IV steroids strep pneumo - IV ceftriaxone with vanc, steroids, and ampicillin

what is the antidote for salicylates overdose?

bicarbonate

what is the antidote for tricyclic antidepressants overdose?

bicarbonate

what type of oral diabetic medication works by decreasing the production of glucose by the liver?

biguanides - metformin (glucophage)

the majority of congenital vertical talus/convex pes planovalgus/rocker bottom flatfoot cases are unilateral/bilateral, and right/left?

bilateral right foot more common

coalitions are more bilateral/unilateral, male/female.

bilateral 50% male more often

what is the primary therapy for hyperparathyroidism?

bisphosphonates surgical tx.

what is a drug for combating osteoporosis?

bisphosphonates raloxifene - SERM, lowers LDL and decreases breast cancer risks.

a systemic infection usually from inhalation that is a single bud off a mother cell attached by a broad base.

blastomycosis

what systemic fungal infx has broad based buds, and bone involvement seen in the mississippi and ohio river basins? how do you treat it?

blastomycosis - pulmonary infection as well itraconazole, for severe amphotericin B

what can you use to offload the 1st met head in cases of sesamoiditis or fractured sesamoids?

dancer's pad

what do you use to treat malignant hyperthermia? which drugs most commonly cause malignant hyperthermia? what is the inheritance of malignant hyperthermia?

dantrolene - IV 2.5mg/kg bolus, oral for 1-3 days after episode. muscle relaxant - succinylcholine inhaled anesthetic - halothane/isoflurane. autosomal dominant

what procedure is a silver but of the 5th metatarsal? and if you include a removal of the inflamed bursa? and if you remove the lateral plantar condyle?

davis - removal of lateral eminence dickson and dively devries

what is the classification for syndactylization?

davis and german incomplete - webbing does not extend to the distal toes complete - extends to the distal toes simple - phalanges not involved complicated - phalanges involved

what is the function of the soleus muscle during contact phase?

decelerates internal rotation of the tibia

what radiographic angles would you look at for determination of a transverse plane flatfoot deformity (AP view)? what procedures best correct this? for sagittal plane deformity (Lateral view)? what procedures best correct this? for frontal plane deformity (calc axial, lateral view)? what procedures best correct this?

decr. talar head coverage(talonavicular congruency), incr. CC abduction angle, incr. talocalc angle. - best corrected with Evans or Kidner decr. calc incl angle, incr. meary's angle, incr. talar declin angle, anterior break in cyma line (always top). - best corrected with TAL or gastroc recession; or Cotton, Lowman, Hoke, miller, Young calc eversion, frontal rotation of 1st met head. - best corrected with calc slide/kouts; or chambers, baker, selakovich, gleich, silver.

how will AVN show up on MRI?

decreased on both T1 and T2 double rim sign on STIR - inner margin will show increased signal intensity, outer margin will show decreased signal intensity.

what are some advantages of external fixation? what are some disadvantages?

decreased soft tissue dissection immobilization of multiple regions allows for post op adjustment skin grafting and wound debridement availability early ROM and WB pin tract infections pain cage rage non unions fracture Neurovascular injury

what nerve is involved in anterior tarsal tunnel?

deep peroneal

what is the best test for adrenal insufficiency, and how would you tell between primary and secondary disease?

early morning plasma cortisol and ACTH levels before and after ACTH stimulation primary - low cortisol and high ACTH - CT abdomen. (adrenal gland) secondary - low cortisol and low ACTH - CT bain (pituitary or hypothalamus)

what is a change in exposed subchondral bone in degenerative joint disease in which it is converted into a dense substance with a smooth surface like ivory.

eburnation

what is mondor's sign? what is it pathognomonic for?

ecchymosis that extends across the plantar foot calcaneal fracture

what type of gland is found all over the body and produce odor free substance? what type of gland is found in the axillae and anogenital regions and produce viscous odorous substances?

eccrine apocrine

how do you diagnose pericardial effusion? how do you treat it?

echo treat the pericarditis - NSAIDS and colchicine

what is the first line diagnostic test for congestive heart failure?

echocardiogram - evaluate structure and function of the heart.

what is the term for when US waves encounter a very dense object? US waves pass through without any echo?

echogenic anechoic - fluid filled cyst - ganglion cyst.

what is the classification scheme for peroneal tendon tears? what is the most common mechanism of injury?

eckert and davis I - retinaculum and periosteum separate from the fibrocartilaginous lip of the lateral malleolus. II - fibrocartilaginous lip of the fibula with retinaculum and periosteum separate from the fibula. III - bone avulsion with retinaculum and fibrocartilaginous lip intact. skiing

what is the portal that allows for flushing and rinsing of joint in arthroscopy?

egress portal

what is the staging classification of charcot?

eichenholtz

what are a the two broad types of bone stimulators?

electric ones that include DC, capacitive and inductive coupling. ultrasound ones

how is dermatomyositis/polymyositis diagnosed and treated?

elevated CPK, elevated creatine, muscle biopsy steroids

treatment for arterial emboli would be? treatment for arterial thrombosis would be?

embolectomy with angiography thrombolysis therapy eg. streptokinase, tpa.

what is a permanent dilation of alveoli with cartilage destruction? what is a hypertrophy of mucus cells causing productive cough for at least 3 months?

emphysema chronic bronchitis

what is the primary classification system for both benign and malignant osseous tumors?

enneking classification

what is the classification for turf toe/1st MPJ dislocation?

jahss type I - dorsal dislocation of proximal phalanx and sesamoids with intersesamoid ligament intact. - hard to close reduce. type IIA - dorsal dislocation of proximal phalanx and sesamoids with ruptured intersesamoid ligament. - easier to close reduce. type IIB - dorsal dislocation of proximal phalanx, transverse fracture of one sesamoid with ruptured intersesamoid ligament. type IIC - dorsal dislocation of proximal phalanx, transverse fracture of both sesamoids with ruptured intersesamoid ligament.

what is the MRI classification for posterior tibial tendon disease?

jahss or Janis type I - tenosynovitis, increased width, and mild longitudinal splits type II - long longitudinal splits with attenuated tendon type III - complete rupture

what is the classification of posterior tibial tendon disease PTTD?

johnson and strom stage I - tenosynovitis and mild degeneration stage II - elongated tendon with degeneration, flexible rearfoot. weak SHR test. stage III - ruptured tendon, inability to perform SHR test, rigid rearfoot valgus, decreased STJ ROM stage IV - same as III, but with rigid ankle valgus

what procedure for the correction of metatarsus adductus is a closing abductory base wedge of all the the mets, with resection of cartilgae from the lesser mets?

johnson osteochondrotomy

are more symptoms relieved with diagnostic arthroscopy by joint lavage or by lysis of adhesions?

joint lavage

what procedure is a transfer of the EHL tendon from the distal phalanx to the head of the 1st metatarsal? what are the indications for the procedure?

jones tenosuspension indications are: pressure under 1st med head, or flexible cavus foot, flexible plantarflexed met head. kirk modification passes the tendon from dorsal to plantar and requires less tendon. the EHL stump is attached to the EHB and arthrodesis of the IPJ is performed to prevent hammering

what is a benign enlargement of the medial plantar digital nerve on the medial aspect of the 1st MPJ of the hallux?

joplin's neuroma

would a junctional nevi be found in the epidermis or dermis or both? would a compound nevi be found in the epidermis or dermis or both?

just the epidermis both dermis and epidermis

increasing kVp/mA produces more penetrating xrays with increased latitude, shorter exposure time, and less xray tube heat, which results in more/less radiation exposure to the patient?

kVP produces shorter exposure time, less heat and less radiation exposure. mA produces more radiation exposure.

what controls the radiographic gray scale or contrast in the film? what controls the quantity or amount of xrays emitted and controls radiographic density? if you increase kVp by 15% (less contrast, higher grayscale) you would do what to mAs? if you decrease kVp by 15% (more contrast, less grayscale) you would do what to mAs?

kVp mA - more radiation exposure cut the mAs in half double the mAs

what are the shaft osteotomy procedures? which can correct elevatus?

kalish - long arm austin scarf - Z cut ludloff - dorsal proximal to plantar distal cut with rotation mau - dorsal distal to plantar proximal cut with rotation. lambrinudi - plantar closing base wedge - corrects elevatus

what total matrixectomy involves allowing the exposed phalanx to be left open and granulating in by secondary intention?

kaplin

what procedure can be done for a haglund's deformity that does not disturb the achilles insertion?

keck and kelly

what arthroplasty procedure is a removal of 1/2 - 1/3 of the proximal phalanx of the hallux?

keller arthroplasty

what is a nodular skin lesion with vascularity and a central depressed area of callus.

keratoacanthoma

what is the only dissociative IV anesthetic, that is an NMDA antagonist, and is a analogue of phencyclidine?

ketamine - schedule III causes nightmares and delirium

Which NSAIDs have fewer pulmonary problems?

ketoprofen and diclofenac

What is the only IV NSAID?

ketorolac (Toradol)

In what age group should bupivicaine be avoided?

kids less than 12

what orthotic modification controls the rearfoot by controlling ground reactive forces?

kirby skive

what angles would you use to evaluate a clubfoot?

kite angle - normal 20-40, clubfoot 0-15 calc incl. - normal 20-25, clubfoot ~17 talar adduction - normal 10-20, clubfoot 80-90 talar plantarflx - normal 25-30, clubfoot 45-65

what is the angle drawn from the long axis of the talus and long axis of the calcaneus?

kites angle - 20-40 increased in pronation

which joint is the main shock absorber during the contact phase of gait?

knee flexion

what procedure performed for frontal plane flatfoot deformity is a medial slide of the calcaneal tuber?

koutsogiannis

what is the classification system for achilles tendon ruptures?

kuwada classification type I - partial tear involving 50% (tears from posterior to anterior) type II - complete tear, <3cm deficit type III - complete tear, 3-6cm deficit. type IV - complete tear with >6cm deficit.

what are some tests to evaluate a hammertoe deformity and possible plantar plate tear?

lachman's test kelikian push up test - push up on the met head - mild hammertoes will straighten, plantar plate tears will result in medial deviated toes.

what are the angles for measuring metatarsus adductus?

lepow technique - line perpendicular to a line that passes along the bases of the 1st and 5th metatarsals compared to a line bisecting the 2nd metatarsal. classic metatarsus adductus angle - lesser tarsus box, with line perpendicular and then compared to the 2nd bisection. engel angle - bisection of the 2nd cuneiform and the 2nd metatarsal. normal for metadductus and lepow is 15, engels angle is 24

anesthesia in an area of infection is more or less effective, why?

less effective because the area is acidic and decreases penetration into the cell.

what are the advantages of intramedullary nails? disadvantages?

less malunion early WB early motion anterior knee pain risk of infection thermal necrosis (reaming) fat emboli (reaming)

what soft tissue procedures can be performed for metatarsus adductus? at what age do you perform these procedures?

less than 3 yrs heyman, herndon, strong thomson lange lichtblau

how many deg of MPJ flexion/extension is normal?

lesser - flexion 30-40, extension 50-60 1st MPJ - flexion 45, extension 70-90

What adverse reaction can β-lactams cause?

leukopenia

intensely pruritic, purple/pink polygonal shaped papules in a network of fine white lines (wickham striae) would be consistent with?

lichen planus also has longitudinal ridges and fissures/split down the nail.

what procedure for the correction of metatarsus adductus is a sectioning of the hyperactive abductor hallucis?

lichtblau

what are the common amide local anesthetics? what are the common esther local anesthetics?

lidocaine/xylocaine, bupivacaine/marcaine, mepivacaine, etidocaine. procaine, tetracaine, chloroprocaine, hexylcaine

subtalar arthroereisis implants are designed to limit STJ motion in what way? They are inserted between which facets?

limit STJ pronation, and heel valgus - thus creating a slightly more supinated foot. (corrects pes planus and over pronation. in the sinus tarsi between the posterior and middle facets. they are direct impact, and axis altering implants

what antibiotics cover VRE?

linezolid or dalfopristin/quinupristin linezolid is the only PO med.

in what types of fractures should you also be looking for a nutcracker fracture? what is a nutcracker fracture?

lisfranc and navicular fractures crush fracture of the cuboid

what are the stages of hardcastle and meyerson classification system, and what is it for?

lisfranc injuries total incongruity type A - all mets together moving lateral or medial. partial incongruity type B1 - 1st met goes medial type B2 - lesser mets go lateral Divergent type C1 - partial 1st medial, some lessers lateral, but not all. type C2 - total. 1st medial, all lessers lateral.

where is the apex of deformity of a metatarsal cavus foot? lesser tarsus cavus? forefoot cavus? anterior cavus?

lisfranc joint lesser tarsus - navicular cuneiform joints chopart's joint - talonavicular and CC joints 1st metatrsal cuneiform joint

fleck sign is the pathognomonic radiographic sign for what type of injury?

lisfranc's fracture/trauma represents an avulsion fx of the 2nd metatarsal base from the lisfranc ligament in 1st intermetatarsal space

what are the rapid acting insulins? short acting? intermediate acting? long acting?

lispro/humalog, and aspart/novolog regular NPH, and lente glargine/lantus, and detemir/levemir

what is the most common vessel involved in thrombophlebitis?

long saphenous vein

what size is the under drill/pilot hole/thread hole for the respective sizes of screws used in fixation? which screw sizes are found in each surgical set?

mini frag set: 1.5 - 1.1 pilot 2.0 - 1.5 pilot 2.7 - 2.0 pilot small frag set: 3.5 - 2.5 pilot 4.0 - 2.5, 2.9 pilot standard/large frag: 4.5 - 3.2 pilot 6.5 - 3.2 pilot core diameter and under drill/pilot/thread hole are the same. overdrill and countersink are the same diameter as the screw. tap is the same size as the screw

a holosystolic, high pitched blowing murmur that radiates to the left axilla would be? a holosystolic, high pitched blowing murmur that increases with inspiration would be?

mitral regurg tricuspid regurg

a mid diastolic, rumbling murmur with an opening snap, that is accentuated by exercise and the left lateral decubitus position would be?

mitral stenosis - heard best at the apex treatment is balloon valvuloplasty

what type of bearing does the three component ankle replacement have?

mobile bearing - third piece is the polyethylene component that is not attached to either side. allows for varus/valgus movement and less stress on the metal to bone interface

what is the infection with a pox virus that results in pearly pink papules with central umbilication?

molluscum contagiosum

what is a contagious viral skin infection that is often sexually transmitted? what causes it?

molluscum contagiosum - discrete smooth umbilicated pearl white papules. poxvirus

what is ecchymosis that extends across the plantar foot? what is it pathognomonic for?

mondor's sign calcaneal fracture

what radiographic view is best for visualizing the entire mortise?

mortise view ankle - 15-20 deg of internal rotation

on diagnostic ultrasound you see discrete well defined round hypoechoic mass. what is it?

morton neuroma

what pattern of bone destruction has less well defined margins with a wider zone of transition from normal to abnormal bone? This indicates an aggressive or slow growing lesion?

moth eaten aggressive - more so than geographic

what is a small ganglion cyst at the distal interphalangeal joint?

mucoid cyst aspirate, inject steoids. 70% recurrence

what is the classification system for medial malleolus fractures? how does each correlate to ankle fracture classification?

mueller class A - avulsion of the tip B - transverse at mortise - SER, PAB C - oblique D - near vertical - SAD

what is the condition seen in COPD patients when the EKG has three or more distinctly different P waves?

multifocal atrial tachycardia - multiple concurrent pacemakers

Punched out lesions or diffusely osteopenic with hair-on-end radiating spicules?

multiple myeloma

succinylcholine is used for? it can cause what adverse reactions?

muscle relaxation through depolarization fasciculations and hyperkalemia

what disorder is made by a peripheral smear showing macroovalocytes and/or bilobed neutrophils?

myelodysplastic syndromes

what complication of MI would have persistent ST Elevation on EKG?

myocardial aneurysm - 1 month post MI treat with warfarin

what is the classification system for digital fractures? what is the treatment for each?

rosenthal class zone I - distal to the distal aspect of the phalanx Treatment: tissue loss of less than 1cm - secondary intention, more than 1 cm - split or full thickness skin graft. zone II - completely distal to the lunula Treatment: atasoy flap - plantar V to Y advancement. or Kutler flap - viaxial V to Y advancement. zone III - distal to the most distal joint. IPJ in hallux, DIPJ in lessers. Treatment: distal symes amp.

what are the classification schemes for pilon fractures?

ruedi and allgower I - non displaced II - significant displacement but without comminution III - significant displacement with comminution ovadia and beals I - non displaced II - minimally displaced III - displaced with large fragments IV - displaced with small fragments V - severe comminution

what complication of MI would have a harsh holosystolic murmur along with LLSB and a thrill?

rupture of the interventricular septum - 3-5 days post MI emergent balloon catheterization/surgical repair.

in regards to external fixators, what technique uses a wire that is bowed across its two points of fixation and then tensioned to provide compression?

russianing

what are the two classifications systems of intermittent claudication?

rutherford and fontaine

cavus foot is primary what plane of deformity?

sagittal

which view on CT has to be requested because it does not naturally come out of the CT and has to be computer reconstructed?

sagittal

what are the types of motion available at the 1st MPJ?

sagittal and transverse plane motions no frontal

what is the name of the depression in the talar surface that runs from anterior to posterior near the anterocentral portion of the ankle joint?

sagittal groove

unilateral external fixators are weak in what plane?

sagittal plane

what flatfoot plane of dominance is the cotton procedure performed for?

sagittal plane

what is the most common organism associated with sickle cell patients with osteomyelitis OM?

salmonella

what is the gold standard classification and imaging modality of calcaneal fractures? what are some other classifications for calc fractures?

sanders class for CT scans - need the coronal plane at the widest portion of the posterior facet. type I - non displaced articular fx type II - two part posterior facet fx type III - three part posterior facet fx type IV - four part/comminuted fx A,B and C further describe the fx from lateral piece to medial. A is lateral, B is central, C is medial rowe, essex lopresti, zwipp

what wound care products are the debriding agents?

santyl, accuzyme, panafil

what nerve is anterior to the medial malleolus?

saphenous

what nerve provides sensory innervation to the dorsal medial aspect of the foot? what nerve provides sensory innervation to the hallux, second digit, and medial aspect of the 3rd digit? what nerve provides sensory innervation to the lateral aspect of the 3rd digit, and the 4th and 5th digits?

saphenous medial dorsal cutaneous (with exception of the adjacent sides of the hallux and 2nd digit - deep peroneal) intermediate dorsal cutaneous

what are the two procedures aimed at repairing the deltoid ligament?

schoolfied - detach reattach more proximal. duvries - cruciate incision and then sutured back together.

CREST syndrome would be most closely associated with?

scleroderma - a systemic disorder of connective tissue characterized by induration, thickening and tightening of the skin./shiny skin. CREST - calcinosis, raynauds, esophageal dysfunction, sclerodactyly, telangiectasias.

what is the oil gland that secretes into the hair follicle especially on the face and neck? what method of secretion do they use?

sebaceous glands holocrine secretion

a greasy, brown, crusty lesion with a classic stuck on appearance on the face or scalp. an erythematous patch with greasy, yellow scales on the eyebrows, or anywhere where there is hair, sparing the non hairy areas of the face/body.

seborrheic keratosis seborrheic dermatitis

at what degree of heart block do you insert a permanent pacemaker?

second degree, mobitz type II and third degree

what is the classification system for nerve injury?

seddon neuropraxia - nerve bruise axonotmesis - axon degeneration by wallerian. neurotmesis - transection

a bruised nerve that results in numbness that is reversible. injury to an axon that results in wallerian degeneration that can regenerate if the gap is not too big. complete severance of a nerve with irreversible numbness.

seddon class neuropraxia axonotmesis neurotmesis

what is a life threatening hypersensitivity to a drug that causes widespread loss of skin covering <10% of the body, biopsy shows basal cell degeneration? if it covers 30% or more of the body, and is full thickness epidermal involvement? if it responds to antibiotics?

stevens johnson syndrome (SJS) toxic epidermal necrolysis (TEN) - burn unit for both ^ , remove all meds. Staphylococcus scalded skin syndrome (SSSS)

what is the classification system for 5th met fractures? which of the classes is the true jones fx?

stewart classification type I - extra articular fx occurring at the metaphyseal-diaphyseal junction - the true jones fx. type II - intra articular avulsion with one or two fracture lines. type III - extra articular avulsion fracture from styloid process from PB. type IV - intra articular comminuted fx. type V - extra articular avulsion fx of epiphysis in kids. (salter harris type I)

what procedure for the correction of metatarsus adductus is an oblique lateral osteotomy of the all the mes

steytler and van der walt

when using an ultrasound bone stimulator, what does it stimulate? the bone heals by what method?

stimulates soft callus formation heals by endochondral ossification

amniotic grafts are applied which side down against the wound?

stomal side down

what arthroplasty procedure is oblique resection of the metatarsal head?

stone - plantar sesamoid articulation is left intact

what is the best test to confirm eradication of H. pylori?

stool antigen or urease breath test

what radiographic view is good for demonstrating anterior ankle impingement?

stress lateral/stress dorsiflexion

what is the management of stable angina? of unstable angina?

stress test, and outpatient aspirin, long acting nitro, beta blocker plus statin. hospitalize, heparin, (IV if angioplasty is planned, LMWH if no angioplasty), aspirin, clopidogrel, nitro, and beta blocker.

what are the four types of collagen, and their primary locations?

strong slippery bloody bowel movement I - strong - bONE, skin, tendon, ligaments, fibrocartilage II - slippery - carTWOledge - articular cartilage (Hyaline) III - bloody - vessels, granulation tissue, lymphatics IV - BM - basement membrane

port wine stain (nevus flammeus) can be associated with what two disorders?

sturge weber syndrome or kleppel - trenaunay - weber syndrome

what is the position recommended for taking off-weightbearing foot orthoses casting?

subtalar joint in neutral, lock the midtarsal joint (by dorsiflexing 4 and 5)

what is the antidote for mercury/arsenic overdose?

succimer

what is the most common cause of adrenal insufficiency?

sudden withdrawal of exogenous glucocorticoids (steroids)

what is the bone loss/osteopenia that is seen late in CRPS?

sudecks atrophy

what type of oral diabetic medication works by binding beta cell receptors to stimulate insulin release?

sulfonylureas - glyburide, glipizide, glimepiride

What are the NSAIDs with the least nephrotoxicity for mild kidney disease?

sulindac

what sign is seen when the toes adjacent to an interspace are splayed apart on wieght bearing?

sullivan sign

when anatomical structure should be considered when making an anterolateral portal/incision? when anatomical structure should be considered when making an anteromedial portal/incision? when anatomical structure should be considered when making a posterolateral portal/incision?

superficial peroneal nerve, lateral to the extensor digitorum longus/peroneus tertius medial to the anterior tib tendon, and lateral to the saphenous vein/nerve. medial to the sural nerve, small saph vein. lateral to the achilles tendon.

What is the most common type of melanoma? Most malignant? Most benign/slowest growing? Typically found on the palms, soles, and nail beds?

superficial spreading nodular lentigo melanoma acral lentiginous - blacks, asians. amelanotic melanoma - last type and may be non pigmented.

what are the borders of kager's triangle?

superior calcaneal surface achilles tendon long flexor tendons

during the contact phase of the gait cycle, what is the position and motion of the subtalar joint STJ? during the contact phase of the gait cycle, what is the position and motion of the midtarsal joint

supinated 2-4 degrees, and pronating 4-6 degrees. supinated, and supination

what total matrixectomy involves no skin incision?

suppan

what phase of a host biologic response to implanted materials is characterized by implant encapsulation, bone resporption and sclerosis? what phase of a host biologic response to implanted materials is characterized by inflammation, immunologic response, and toxicity? what phase of a host biologic response to implanted materials is characterized by cellular response and carcinogenic response?

tissue remodeling cellular response immunologic response

what are the tests involved with non invasive vascular studies?

toe brachial index (TBI) ankle brachial index pulse volume recordings (PVR) transcutaneous oxygen monitoring (TCOM) skin perfusion pressure (SPP)

what is the only NSAID approved for children?

tolmentin/tolectin 200-600mg PO tid and ASA

what shoe modification is used to prevent heel slippage?

tongue pad

what type of essex lopresti results from vertical force? what type of essex lopresti results from anterior to posterior force? which is worse?

tongue type - no STJ involvement joint depression - STJ involvement - worse

what is the classification for describing potential for non union in a jones fracture?

torg class type I - acute jones type II - delayed union type III - non union

what type of atrophic non union has an intermediate fragment with decreased/absent blood supply that heals to one main fragment, but not the other?

torsion wedge

what is the gold standard for offloading diabetic foot ulcers?

total contact cast difficult and lengthy to apply, and doesn't reimburse well. other options are bledsoe boot, IPOS shoe, orthowedge shoe,reverse IPOS, CROW boot.

What study is most useful in searching for metastatic bone disease?

total skeletal bone scan

what are the steps of treatment of a hallux varus?

total soft tissue release of the 1st MPJ medial capsulotomy tibial sesamoidectomy transfer of EHL to the plantar lateral aspect of the proximal phalanx osteotomy (reverse austin) arthroplasty or implant arthrodesis

what is a sunburn like rash on the palms and soles in systemic hypotension and very sick patients caused by from retained foreign bodies?

toxic shock syndrome bacterial exotoxins

First choice for non-narcotic oral medication?

tramadol (Ultram) 50 mg one to two tabs PO q4-6h prn pain, max daily dose of 400 mg per day

what is the dosage for ultram/tramadol? what is the dosage for toradol/ketorolac?

tramadol 50 mg - 1-2 tabs PO q4-6° prn pain 30 mg IV q6h ketorolac 10 mg - 1 tab PO q4-6h prn pain

what is the bridle procedure? who is it done for?

transfer of the tibialis posterior and anterior and the peroneus longus for CP patients (no dorsiflexion power, lots of equinus) the three tendons are transferred to the dorsum of the foot to aid in dorsiflexion power.

what is the treatment for acromegaly?

transsphenoidal surgical resection - best initial treatment octreotide or lanreotide drug of choice for recalcitrant cases.

what are the two axis of motion for the 1st MPJ? what planes of motion do those axis allow?

transverse and sagittal axis. transverse axis allows sagittal plane motion sagittal axis allows transverse plane motion There is no frontal plane motion in the 1st MPJ.

what is the order of fracture patterns in regard to stability?

transverse oblique spiral comminuted

what flatfoot plane of dominance is the evans procedure performed for?

transverse plane

what are the fracture patterns? which is the most stable pattern?

transverse, greenstick, torus, oblique, comminuted transverse

what is injury caused by prolonged immersion in cool/cold water.

trench foot/immersion foot - becomes swollen, waxy, and mottled. blistering, swelling, and ulceration can occur.

what is the cause of a pseudojoint in bone healing?

typically has adequate vascularity, but excessive motion/instability.

how do you diagnose Herpes?

tzanck smear - treat with acyclovir

what test is used to differentiate between deep and superficial venous incompetence?

trendelenburg test elevate the leg to empty venous blood, put a tq around the upper thigh at 30-60mmhg and have the patient stand. if the varicosities fill within 20-30 sec. deep and superficial incompetence. If the varicosities do not fill after 30 sec. release the tq, if the varicosities return quickly the source is superficial alone.

what are possible methods of anchoring tendon to bone?

trephine plug - replace the plug with the tendon in it three hole suture - tendon passed through the hole and tied on the other side buttress and button anchor - suture passed through bone and sutured to a button tunnel with sling - tendon passed through a hole and sutured to itself. mason-allen stitch with tendon screw and washer bone anchor

what structures limit dorsiflexion at the ankle joint? what structures limit plantarflexion at the ankle joint?

triceps surae posterior deltoid ligament PTFL osseous limitation where the talus becomes wider in the joint. ATFL ligament posterior tubercle of the talus

severe paroxysmal lower jaw and facial pain that is worsened by light touch, cold breeze, chewing etc would indicate? how do you treat it?

trigeminal neuralgia carbamazepine

if you are going to use a splint to abduct the foot, what should be used to prevent subluxation of the MTJ?

triplanar varus wedge

what is the treatment for H. pylori infection?

triple therapy: PPI, amoxicillin, clarithromycin (CAP)

what is the triad of tetanus symptoms?

trismus - lockjaw risus sardonicus - spasm of the facial muscles causing grin. aphagia

what is the instrument with a sharp point used in arthroscopy to piece soft tissue? what instrument has a blunt tip?

trocar - after the soft tissue and capsule is pierced it is removed and the cannula is left in place. obturator - used to penetrate a joint when placing the cannula in an already established portal.

what is the basic mollecular unit of a tendon?

tropocollagen - composed of type I collagen fibers I strong II slippery III bloody IV bowel movement (BM) basement membrane

what is the best serum marker for recent MI? what is the best serum marker for reinfarction?

troponins creatinine kinase - CK-MB

a child/newborn that has a hypopigmented spot thats positive on wood's lamp as an ash leaf spot would be pathognomonic for? what other lesions would you look for?

tuberous sclerosis - get CT of the head to see the tubers in the brain. Shagreen patches (elevated fleshy collagen plaques) Adenoma Sebaceum (hyperplastic blood vessels)

Malignant tumors are subcategorized as low-grade or high-grade based on their histologic characteristics including?

tumor necrosis, cellular anaplasia, and the number of mitotic figures

if a pediatric patient underwent casting for immobilization and fixation of a congenital disorder, how long do you splint them?

twice as long as the casting period

what can be used to treat scissor gait of CP patients?

twister cables belt around the waist with cables inside the leg down to the shoe that control the abduction at heel contct

when measuring crutches the height should be where? the hand piece should be adjusted to allow _____ deg of elbow flexion. when measuring canes, you would size it be measuring from the _____ to the ground. the elbow should be flexed _____ deg. the cane is held in which hand?

two fingers between the axilla and the pad 30 deg of flexion greater trochanter to the ground 30 deg. opposite the affected leg or foot.

which of the salter harris fracture patterns is most likely to cause premature physeal closure?

type 5

what is the AO classification for tibial plafond pilon fractures?

type A - extra articular 1 - metaphyseal simple 2 - metaphyseal wedge 3 - metaphyseal complex/comminuted. type B - partial articular 1 - pure split 2 - split depression 3 - comminuted with depression. type C - complete articular 1 - Articular simple, metaphyseal simple 2 - Articular simple, metaphyseal multifragmentary 3 - Articular, metaphyseal multifragmentary

how is brachymetatarsia classified?

type I - shortening of the 1st only type II - shortening of 1 or 2 of the lessers type III - shortening of the 1st and one or more of the lessers. type IV - shortening of all metatarsals

what type of allergic reaction is anaphylaxis? what is a reaction similar to anaphylaxis but can occur after the first exposure?

type I antibody mediated hypersensitivity reaction - can only occur after previous exposure to the antigen. anaphylactoid reaction - contrast dyes, NSAIDs, ASA.

what type of EKG cardiac rhythm shows PR intervals progressively lengthening until a QRS is dropped, and then repeat?

type I second degree heart block (wenckebach)

what type of EKG cardiac rhythm shows not all impulses reaching the ventricules, but no prolongation of the PR Interval?

type II second degree heart block (mobitz)

poison ivy/oak etc is what type of hypersensitivity reaction?

type IV

barking cough with fever is called? caused by?

croup parainfluenza virus cool air and steroids help

what would you use to work up a PE?

d dimer (if high requires further testing) duplex scan for DVT - V/Q scan - spiral CT (expensive and lots of radiation)

Which is stronger - the lateral ankle ligaments or the deltoid ligament?

deltoid ligament

what deformity will result from cutting quadratus plantae?

digits 4 and 5 will become adductovarus

how to break an SVT (supraventricular tachycardia) in infants?

envelope their face in ice adenosine push in a couple seconds.

you would see spontaneous pneumothorax on inspiratory or expiratory chest X ray?

expiratory films - easier to see

what structures in the lisfranc joint are not connected by interosseous ligaments?

1st and 2nd metatarsals do not have an interosseous ligament attachment between them.

blood cultures should be drawn from ___ sites, ______ apart.

2 sites, 20 min apart

1 % point of HbA1c, equals approximately how many glucose points?

20 glucose points

how many bones in the foot?

26

what is the normal value of pre albumin?

19-36 mg/dL

what layer of the foot does the FDL run?

2nd layer

what is the normal C02?

30-35 maybe up to 40 if you breath slowly

neutrophils/granulocytes normally take about ______ to mature, and functionally last about _____.

8-14 days 1-2 days

what is the normal ESR rate? moderate elevation? severe elevation? diagnostic for OM?

<20 mm/hr 20-60 mm/hr >60mm/hr >70mm/hr

what are the ABIs and their assoc. indications? at what ABI is compressive therapy contraindicated?

>0.9 - good healing potential 0.5-0.9 - PAD and delayed healing <0.5 - ischemia and problematic healing less than 0.8

transcutaneous oxygen (TcPO2) of _______ is assoc. with good healing potential. transcutaneous oxygen (TcPO2) of _______ is assoc. with microcirculatory problems and delayed/problematic healing.

>30 <20

what are the stages of PEDIS ulcer classification?

PEDIS is an acronym standing for: Perfusion Extent/size Depth/tissue loss Infection Sensation -Each of the 5 categories is graded from 0 (minimal) to 2 (severe). -Based on a 10-point scale with 10 being most serious ulcer with greatest difficulty in treatment.

cellulitis would show what on MRI? abscess would show what on MRI?

T1 - diffuse decreased signal intensity T2 and STIR - increased signal intensity T1, T2, STIR - increased signal intensity

the medial compartment communicates to the central compartment and vice versa via the?

adductor hallucis tendon flexor hallucis longus tendon peroneus longus tendon neurovascular structures

what are the attachments of the lisfranc ligament?

attaches the lateral aspect of the medial cuneiform to the medial base of 2nd metatarsal?

what ligaments compose the bifurcate ligament? which is strong and narrow? which is broad but weak?

calcaneonavicular ligament - strong and narrow calcaneocuboid ligament - broad and weak

what is the difference between a coalition and a bar?

coalition - intra articular fusion bar - extra articular fusion

what virus causes pericarditis?

cocksackie B virus

is stridor an inspiratory or expiratory? upper and lower airway? wheezing is inspiratory or expiratory? upper or lower airway?

inspiratory and upper airway expiratory and lower airway

are sesamoids intra capsular or extra capsular?

intra capsular

type and screen means type and cross

just looks at the blood for antibodies and type of blood. checks what blood in the bank can be used with the patient.

which level of anesthesia is considered surgical anesthesia? this level is divided further into four planes, what are those planes?

level III level II is the one you pass through as fast as possible. level IV is coma level I is the initial IV anesthesia level 3 has four planes: Plane I - automatic respiration loss of eyeball movements loss of Eyelid reflex swallowing reflex disappears conjunctival reflex is lost Plane II - Laryngeal reflex is lost corneal reflex disappears secretion of tears increases automatic respiration Plane III - Diaphragmatic respiration loss of pupillary light reflex. complete abdominal relaxation This was the desired plane for surgery when muscle relaxants were not used. Plane IV - complete intercostal paralysis to diaphragmatic paralysis (apnea).

the lateral compartment communicates to the central compartment and vice versa via the?

long flexor tendon to the 5th digit short flexor tendon to the 5th digit lumbrical muscle to the 5th digit (4th lumbrical) plantar interosseous muscle to the 5th digit (3rd plantar interossei) peroneus longus tendon neurovascular structures

what is the origin and insertion of the capsularis tendon?

origin - extensor hallucis longus muscle insertion - 1st MPJ capsule

name the ossicle: Between 1st cuneiform and 1st and 2nd metatarsal bases Proximal 5th metatarsal base Accessory navicular Dorsal aspect of navicular Distal to lateral malleolus

os intermetatarsium os vesalianum os tibiale externum os supranaviculare os subfibulare

name the ossicle: Sesamoid bone in PB tendon Dorsal, anterior process of calc Posterior aspect of sustentaculum tali Posterior aspect of talus (Steida process) Distal to medial malleolus

os peroneum os calcaneus secondarius os sustentaculi os trigonum os subtibiale

what structures attach to the fibular sesamoid?

plantar met phalangeal ligament lateral met sesamoidal ligament intersesamoidal ligament phalangeal sesamoidal ligament FHB tendon ADH tendon

what type of angina occurs at rest, increases in time, and not easily relieved?

unstable angina

best view for free air in the abdominal area is?

upright chest xray

most common reason for dysuria in young girls? most common reason for dysuria in young boys?

vulvovaginitis meatal stenosis