Part 2 Boards Question journal/Crozer/Prism
4 most common EKG findings
" 2 Fibs and flutter" 1. Atrial Fibrillation 2. Atrial Flutter 3. Ventricular Fibrillation 4. AV block FA284
how to treat hyperkalemia
" C BIG K" Ca (stabilize membrain potential) Bicarb Insulin Glucose (those 3 (+) K back into cells Kayexelate
AML
"15:17 year olds at AML shopping for AUER RODS" t(15:17) Auer rods
what are the 4 hypersensity types: give examples of each
"ACID" type 1: anaphylactic type 2: cytotoxic (autoimmune, transfusion) type 3: immune complex (serum sickness, arthus, SLE) type 4: delayed (transplant, T cells, TB, touching contact dermatitis
abx that dont need renal dosing (7)
"ADAPT CM" Amoxicillin (good for preop bacterial endocarditis) Doxycyclin Azithromycin (avoid with liver dz) Penacillin VK Tetracycline (avoid with liver dz) Clinidamycin Metranidazole
ALL
"ALL KIDS know 12:21" <15 years, t(12:21)
Micro options that cause gas (6)
"BECKSP" Bacterodes Ecoli Clostridium Klebsiella Serrattia Pseudomonas
Cavus foot type seen in what pathologies
"CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.
Drug induced SLE (6)
"CHIPP G" Chloropromazine Hydralazine Isoniazid Procainamide Penicillamine Griseofulvin
Pes cavus surgical correction (7)
"COLE DUVRIES a mexican JAPAS washing his JAHSS in a CAVE and DWYERing it MCEVENNy saying DFWO" 1. *C*ole: Dorsiflexory wedge of naviculo*c*unefiromr and *c*uboid 2. Japas: V-osteotomy of midfoot with apex of V at navicular 3. DuVries: Dorsiflexory wedge or fusion of MTJ (CCJ,TNJ) 4. Dwyer: Lateral closing wedge or open medial wedge 5. *M*cEvenny: Dorsiflexory fusion of 1st *met-m*edial cuniform joint 6. DFWO: Dorsiflexory wedge osteotomy of 1st met or all mets "$*F*@# them all" 7.JAHSS: dorsiflexory wedge osteotomy across tarsometatarsojoints
multiple myeloma symtoms
"CRAB" hyperCalcemia Renal involvment Anemia Bone lytic lesions/Back pain, Bence jones
Thiazide drugs (4)
"Colored Water Met Indian in Thialand" Chlorothiadone Hydrocholorthiazide Metolazone Indapamide
causes of gout (7)
"D CHAMPS" -DM -Cerebral Palsy -Hereditary insensitiity to pain, Hansen Dz -Alcholism -Myelodysplasia, meninomyleocele -Poliomylitis, Peripheral neuropathy -Syphilis, spinal or peripheral n. injury, spina bifida
name 5 Causes of peripheral neuropathy (12)
"DANG THE PRIST" D iabetes A myloid N utritional (eg B12 deficiency) G uillain-Barre T oxic (eg amiodarone) H eriditary E ndocrine R ecurring (10% of G-B) A lcohol P b (lead) I diopathic S arcoid T hyroid
most common DMARDs
"ELISA Please Give Her Methotrexate" Etanercept Leflonomide Infliximib Sulfasalazine Ankarina Penicillamine Glucocorticoids, Gold salts Hydroxychloroquin Methotrexate
Flat foot surgical correction options? (13)
"EVANS is a TRANY KIDner Evans Kidner "a YOUNG LOWMAN picking COTTON drinking a MILLER is a HOKE becuase he SATtigal" Lowman cotton Hoke Miller young "SELAKOVITCH BAKING in her the FRONT of her CHAMBERS" chambers baker Selakovitch "the SILVER KOUTS is a GLIECH.. CALCulate it" Gliech Silver Koutsogiannis
Loop diuretics (4)
"Etham Bum Tor in a Loop on the Floor" Ethacrynic Bumetanide Rorsemide Furosemide
what are the benign bone tumors
"FOG MACHINES" Fibrous dysplasia Osteochondroma, osteoid osetoma Giant cell tumor Myeloma ABC Chondroblastoma Hemangioma Infections Non ossifying fibroma Enchondroma Solitary bone cyst C91
Intrinsic hemolytic normocytic anemias (6)
"G6PD looking with thier SPEREOcytosis at NOCTURNAL is KINd of SICKle. They are DEFECT?" G6PD deficiency Hereditary spherocytosis Paroxysmal nocturnal deficncy Sickle cell anemia *(crisis=infection)* Pyruvate kiase deficiency HbC defect
epipyseal tumors include (4) vs diaphysis tumors (4)
"GIANT CHON is CLEARly INTEResting" Giant cell tumors Chondroblastomas (malignant) Clear cell chondrosarcomas (malignant) Interosseus ganglions "EW we MET MULTIPLE PERI, im gonna DIE" Metastasis Ewings sarcoma periosteal osteosarcoma Multiple myleoma
hypochromic microcytic anemias
"ISALT" -Iron deficinecy -Sideroblastic anemia -Anemia of chronic disease (can also be normocytic -Lead -Thalasemia W322
Anesthesia medications main use in OR: -preop anxitiey -induction of anesthesia and pain releif -start and maintan anestheisa -maintenance of anesthesia
"MFKP" "My First Kiss Please" -preop anxitiey: Midazolam -induction and pain releif: fentanyl -indcution and maintain: Ketamine -induction and mantain: Propofol (milky)
Treatment for Congestive Heart Failure?
"MOISTDADS" Morphine Sulphate O2 (4 L/min) IV fluids (to decrease HR) Sit up (Semifowler) Tourniqet Diuretic (Lasix: 20 or 40mg) Access ins/outs, Digoxin (chronotropic vs inotropic) Serum vit K (20 or 40mg)
MI what is order of treatment (6)
"MONA BeHave" Morphine O2 Nitroglycerin Aspirin Beta blockers Heparin
O' Donoghue classification
"O D*%&# I SPRAINED my ankle" L collateral ligament injury 1. ATFL 2. ATLF + CFL 3. ATFL + CFL +PTLF
CLL/SLL
"OLD waiting for a CLL while they SMUDGE themselves" >60 years old Smudge cells
CML
"Philadelphia CML at 9:22am" Philadelphia 9:22
OKC motion for supination
"SADIP" Supination: Aduction, Inversion, plantarflexion
5 types of shock? most common?
"SCHAN" -Septic (infection) -Cardiogenic (myocardial dysfunction) -*Hypovolemic (loss of blood)* -Anaphylactic (allergic reaction) -Neurogenic (spinal cord injury)
4 drugs that cause malignant hyperthermia
"SHID" Succinylcholine (muscle relaxant) Halothane (inhaled anesthetic) Isoflurane (inhaled anesthetic) Desflurane (inhaled anesthetic)
which halothane is the only one approved for anesthesia induction? It is also best used in asthmatic pts b/c is sweet smelling
"Stevo best introducture to jackass and is sweet smelling" Sevoflurane(etheralso)
best way to describe a fracture to your attending?
"TOE LARD LAD" • Type: transverse, oblique, spiral, comminuted (stability) • Open/closed • Extra/intraarticular • Length • Angulation: saggital, frontal • Rotation: transverse • Displacement: mild, mod, severe. • Location: diaphysis, metaphysis, epiphysis • Alignment: good, poor • Direction of fx line
Flat foot surgical correction in sagittal plane (5)
"YOUG LOWMAN picking COTTON and driking a MILLER is a HOKE, 1. Lowman: (Plantarflexory TN wedge athrodesis with TAL, tibialus anterior tendon rerouted under navicular to support arch, slip of achilles tendon is attached to medial arch) 2. Cotton: Open dorsal wedge of 1st Cuneifom 3. HOKE: Plantar base wedge athrodesis of navicular, 1st and 2nd cuneiform, TAL 4. Miller: Plantar base wedge of Navicula-1st cueniform and 1st cuneiform metatarsal fusion 5. Young (keyhole): reroute anteior tibial tendon through keyhole in navicular without detatch insertion, with poserior tibial tendon advancement under navicular
Pseudomonas drugs (7)
"ZAC GIFT" Zosyn Aztreonam Cipro (oral) Gentamycin Imipenem (oral) Fortaz (ceftazidime) Timentin
hydrolized time Chromic (natural) Vicryl (braided synthetic) PDS (monofilament synthetic) Monocril (monofilament synthetic) Dexon (braided synthetic) Maxon (monofilament synthetic)
"backwards alphabet: shortest chormic, V,P,M,D, Maxon to longest" Chromic: 20 days Vicryl: 80-120 days PDS: 90 days Moncoril: 90-120 Dexon: 100-200 days Maxon: 180 days
what ar the AO principles of internal fixation? (4) what creates osteogenic properties of interal fixation?
"dont RAPE our pts" 1. Rigid internal fixation 2: Anatamical reduction 3: Preserve ST and vasculature 4: Early ROM lack of motion creates ostegenic, not compression
5 reasons why a prreop EKG is recomended
"dont be a DICCC, get an EKG" 1. DMII 2. Ishcemic cardiac disease 3. CHF 4. Creatine levels >2.0 5. Cerebrovascular disease
bone tumor more commonly found in females
"female shop at GAP" Giant cell tumor ABC Parosteal osteosarcoma
MRSA drugs (5)
"hey CLINDA get your DOG and FOX in the BAC of the VAN" clinidamycin doxyclyclin (minicyclinc) zyvox Bactrim Vanco
closed kinetic chain supination of STJ
"iC eT Tabd" inversion of Calc external rot of Tibia Ab and dorsiflexion of Talus
increasing the kVp nemonic: -shades of grey? -lenghthening? -density? -penetration? -ray beam strenght? -absorption by sourrounding tissues? -contrast? -quality of xray? -exposure time? -xray tube heat? -exposrure to pt?
"increasing kVp increases GLAD POB" increase Grey Scale (overexpose) increases Lengthening increases Asorption by tissues increases Density (overexpose) increased penetrating xray increased stronger the ray Beam LOWERS QUALITY: "V for Visualize the grey" reduces contrast lowers xray quality shorter exposure time less xray tube heat less exposure to pt W198
max dose in mg/kg for: lidocaine lidocaine w epi marcaine marcaine w epi what needs to be done to convert mg to ml (cc) which local is not given to children <12 years old?
"less more less more" 300mg 500mg 175mg 225mg (to figure out what the max ml for above just divide by what percent the drug is: lidocaine 1% max ml would be 300/10= 30ml Marcaine isn't given to kids <12 years old
ectrodactyly
"lobster claw" "cleft foot" congenital absence of 2 or more central rays affects 2nd nad 3rd most often
foreign body classifications (2)
"redneck Patyk gets a splinter" Resnick Patzakis
foot appearance in frontal plane with closed kinetic chain supination (3)
"stacking" "higher" "thinner"
Flat foot surgical correction in frontal plane (3)
"the SELAKOVICH BAKER in his CHAMBER full FRONTAL" 1. Chambers: raise posterior factet of STJ using bone graft under sinus tarsi 2. Baker: Osteotomy inferior to the STJ posterior facet with bone graft 3. Selakovich: Opening wedge osteotomy of sustetaculum tali with bone graft which restrics abnormal STJ motion 4.Kouts 5. opening wedge dwyer
what are the 3 plastazote durometers and uses
#1 plastazote (pink) 15-20 durometer, topcover for neuropathtic pts #2 plastazote (white) 35 durometer, topcover or shell for DM #3 plastazote (black) 45-65 durometer, shell material for athletes
bone scan for acute OM or septic arthritis
(+) tech and (+) gallium
bone scan for choric OM,
(+) tech and (-) gallium
bone scan for osteoarthropathy
(+) tech and (-) gallium
bone scan for stress fracture
(+) tech and (-) gallium
what about tobacco and nicotine is detremental to bone healing?
(-) bone morphogenic protines (a group of cytokines and growth factors that induce bone and cartilage formation)
bone scan for celluitis
(-) tech and (+) gallium
why are salicylates like asprin contraindicated in gout pts
(-) uric acid excretion
what is cockcroft-galt equation
(140-age) x kg weight/ (72x serum cr) x 0.85 F
Gallium-67 Citrate use (2)
(binds WBC) chronic infections (6-24 hours) tumors (24-72 hours)
Contraindications for nuclear medicine (2)
(bone scan) -Pregnancy -kidney dz
Hyperthyroidism symtoms (8)
(decreased TSH but increased total T3,T4=increases metabolic rate) heat intolerance weight loss (increased appitite) hyperactivity diarrhea increased relfexes Pretibial myexedema, proptosis, exapthalmos warm, most, fine hair Chest palpitations, arrythmias
calculate the Odds Ratio in a Case-control study or cohort? (rare diseases) In a group of 100 smokers, 40 people developed lung CA while 60 people did not. In a similar group of 100 non-smokers, lung CA developed in 10 people.
(exposed with dz/exposed without dz) / (# not exposed with dz/ # not exposed without/ dz 40/60=0.67 / 10/90=0.11 0.67/0.11= 6 smokers are 6 times as likely to develop lung CA than non smokers. In a group of 100 smokers, 40 people developed lung CA while 60 people did not. In a similar group of 100 non-smokers, lung CA developed in 10 people. The odds of a smoker developing lung CA would be 40/60=0.67, whereas the odds of a non-smoker developing lung CA would be 10/90 = 0.11. The odds ratio is then 0.67/0.11, or 6, meaning that smokers are 6 times as likely to develop lung cancer than non-smokers. An odds ratio of 1 indicates no difference between groups.
Beck Triad
(findings for cardiac tamponade) hypotension, distended neck veins, distant heart sounds
joint type in foot: Planar (3)
(gliding or plane) Lisranc, intercarpal, MTJ
Schedule II drugs (3/10)
(high abuse, no refills or verbal orders) Cocaine Methamphetamine Methadone Hydromorphone (Dilaudid) Meperidine (Demerol) Oxycodone (OxyContin) Fentanyl Dexedrine Adderall Ritalin
joint type in foot: Ginglymus (hinge)
(hinge) IPJ
A,B,C of the Sanders CT classification further describe the Posterior facet fx of cal in what direction
(lateral -> medial) - A/B divide posterior facet into equal 1/3s - C divides posterior facet from sus tali
Schedule I drugs include (6)
(no medical use, high abuse) Heroin Lysergic acid diethylamide (LSD) Marijuana (cannabis)* Methylenedioxymethamphetamine (ecstasy) Methaqualone Peyote
joint type in foot: Trochoid
(ring and pivoit) none in foot. Atlantoaxial (C1 and C2)
joint type in foot: sellar (saddle)
(saddle) CCJ
calculate accuracy
(true +) + (true -) / total population
Woods light examination colors: Red= Bright Green= Green= Gold= Accentuated hypopigmentation=
*-Red= Erythrasma* -Bright Green=Tinea Capatis (Microsporum canis) -Green= Pseudomonas -Gold= Tinea Versicolor -Accentuated hypopigmentation= Ash leaf macule (pic)
talar declination angle
*-normal is 20* -seen on lateral -flat foot is increased declination
*Answer the following for #s 1-5 muscular dystrophy's:* -trait? -issue? -onset/ death -symptoms 1.Becker muscular dystrophy 2.Emery-Dreifuss 3.Duchenne's 4.Facioscapulohumeral 5.Limb-Girdle
*1. Becker muscular dystrophy* -x linked recessive -abnormal dystrophin -age of onset 5-25, wheelchair by age 20-50 , life expectancey 40-60 yrs due to respiratory failure -pseudohypertrophy calves w/ slower progression, no IQ issues, waddling gait, lordosis, cramping with exertion *2. Emery-Dreifuss* -x linked recessive -age of onset 5-15, die due to cardiac arrythemias -stiffening of spine, upper arms, peroneals, toe walking, contracted elbows *3. Duchenne's* -x linked recessive - age of onset 2-5, wheelchair bound by 10-12yr, die around 20 due to respiratory and cardiac arrest -toe walking, difficulty climbing stairs, lordosis, waddling gait, gower sign, decreased IQ, pulmonary disorders *4. Facioscapulohumeral* (pic) -autosomal dominant -age of onset is 7-20, normal life span -foot drp, popeye arms (distal arms spared) *5.Limb-Girdle* -autosomal recessive -age of onset 10-30, variable rate of progression, falling over due to m atrophy
4 schools of jurisprudence
*1. Formalism*: law is a science *2. Realism*: law is just another name for politic *3. Positivism:* law must be confined to the written rules and regulations enacted or recognized by the government *4. Naturalism:* law must reflect eternal principles of justice and morality that exist independent of governmental recognition
3 types of *dermatophytes?* 4 subtypes of Trichophyton? most common trichophyton? which tricophyton is moccasin? vesicles?, head? foot?
*1. Microsporum*: animal source-canis, human source-audouini, soil source-gypseum. green under UV light *2. Epidermophyton* (skin and nails) *3. Tricophyton* -Tricophyton rubrum (most common foot), moccasin distribution -Tricophyton mentagrophytes (2nd most common foot, vesicles and bulla -Trichophyton tonsurans (head) -Trichopyton schoenlienii (head)
most common location for gout attack (3)
*1st MTPJ* lisfranc heel
what is normal for a Q angle measurement
*<15* >15 indicates genu valgum <10 indicates genu varum
Tx for Seborrheic dermatitis (cradle cap) (2)
*Antiseborrheic shampoo* -1% selenium sulfate suspension, zinc pyrithin (head and shoulders) -tar derivatives (T/Gell) *hydrocortisone creams*
how to fix white toe syndrome (7)
*Arterial* -place foot in dependant position -lossen bandages -twist K wire -apply heat to small of back -PT block -Remove K wire -Remove dressings consider opening
Which of the RICE therapy after fracture is most important: -Rest: decrease edema, prevent displacement -Ice: 20 min on, 20 min off. Decrease edema and pain -Compress/immobilize:maintain alignment, decrease motion, decrease edema, -Elevate: decrease edema, pain, above heart (~45 degree)
*Compress/immobilize:* most important, maintain alignment, decrease motion, decrease edema
study that measures both risk factor (alcohol abuse) and outcome (depression) at the same time. Its a snapshot in the data. its the best study type of determine prevelance.
*Cross sectional study.* (Prevelance: the number of cases (disease) divided by divided by total amount of people. in a specific amount of time.)
measues biological damage caused by radiation
*Dose equivalent* vs measres biological damaged caused by radiation to a specific part of the body(Effective dose equivalent)
Etomidate is commoly used in what medical setting/why? AE?
*ER settings* b/c its a *rapid short* acting IV anesthetic that can be used in concious sedation as well as rapid induction into general anesthesia. It is *safe in pts with comprimised myocardial contractility* and who are hemodynamically unstable as it *doesnt drop the blood pressure* AE: Adrenal suppression
measres biological damaged caused by radiation to a specific part of the body
*Effective dose equivalent* "damage effects" vs measues biological damage caused by radiation (dose equivalent)
endemic disease (3) vs pandemic disease (3) vs Epidemic disease(4)
*Endemic* disease constantly present in a speficicaly smaller grouped population -common cold -chicken pox -malaria vs *pandemic*:is a global or multiple county outbreak. -HIV/AIDS, -Flu (aisian/spanish) -SARS, vs *Epidemic* *rapid and short* spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. -meningococcal infections -black plague -yellow fever -polio
"Shepherd's Crook". "Sabre Shin".
*Femoral Bowing*- Anterior Tibial Bowing - Pagets
what is proton density? In general how does an MRI work? Define BO and what MIR is it assoicated with? T1 MRI def? -hyperintense with? (4) -referred to as? vs T2 MRI def -hyperintense with? (4) -referred to as?
*General MRI: The proton density depends on proton density within the tissue volume*- the magnetic wobble or spin of protons align when an external magnet is applied. Once allined a rradio frequency is applied which causes the protons into a higher Energy which is transmited to the image. Differing image comes from different speeds of realignment within in different tissues. *T1*: speed to realign the *static magnetic vector aka BO, * following a radio frequency excitation pulse hyperintense signal with -fat, bone marrow, nerves, lipomas (referred to as anatomic image) vs *T2*: how quickly the transverse magnitation decays over time. speed of *axial spin* returns to resting via 90 degree pulse hyperintense with water, fluid filled tumors, inflammation, blood, edema. (referred to as pathologic image) W208
HLA-B27 diseases? HLA-B27= sero neg/pos,
*HLA-B27 = RAPE B Wipped /seronegative* (Reiters disease, ankylosing spondylitis, Psoriatic arthritis, IBS, Behcet's disease Whipple's disease -seropositive=Rheumatoid arthritis.
Hyperthyroidism diseases (5) vs Hypothyroidism disease (7)
*Hyper: increased T3/T4/decreased TSH -Graves (most common) -Toxic multinodular goiter -Thyroid storm -Jod-Basedow phenomenon -Thryrotoxicosis Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens
Intensity of a beam is 100mR at a distance of 1m, what is intensity at 3m.
*Inverse Square law* Intesnity 1=distance 2^2 over Intensity 2= distance 1^2 100=3^2 over x=1^2 9 x=100 x=11.1
Turf toe classification types: which types can be closed reducible? which types rupture the intersesamoidal lig? which type is the avusion fx? which type needs ORIF because it cant be closed reduced?
*Jahss classification* type I: Dorsal dislocation of prox phalanx, met punctures plantar capsule. -Intersesamoidal *lig remains intact* -no fx. -*Cant* be close reduced becuase deformity is tight, -needs ORIF type IIA: Dorsal dislocation of prox phalanx, met punctures plantar capsule. -intersesamoidale *lig ruptured*, -sesamoids no longer remain apposed to eachother, -*able* to close reduce type IIB: Dorsal dislocation of prox phalanx, met punctures plantar capsule. -intersesamoidal *lig intact*, -transverse *avulsion fx* of one of sesamoids. -*Able* to close reduce
Lowman flatfoot correction
*Lowman: (Plantarflexory TN wedge athrodesis with TAL, tibialus anterior tendon rerouted under navicular to support arch, slip of achilles tendon is attached to medial arch)* 2. Cotton: Open dorsal wedge of 1st Cuneifom 3. HOKE: Plantar base wedge athrodesis of navicular, 1st and 2nd cuneiform, TAL 4. Miller: Plantar base wedge of Navicula-1st cueniform and 1st cuneiform metatarsal fusion 5. Young (keyhole): reroute anteior tibial tendon through keyhole in navicular without detatch insertion, with poserior tibial tendon advancement under navicular
*absorbable suture?* 1. Natural (2) 2. Synthetic -(3 monofilament), -(2 Braided)
*NATURAL* Monofilament: 1. Chromic gut (Surgigut) 2. Plain gut (Surgigut) *SYNTHETIC* Monofilament: "di, gly, gle 1. PDS (Polydioxanone) 2. Maxon (Polyglyconate) 3. Monocryl (Poliglecaprone) Braided: "gal, gly" 1. Vicryl (Polygalactin 910) 2. DEXON (Polyglycolic acid) PGA "poly*g,d* are absorbable"
Eckert and Davis: Classification
*Peronenal tendon subluxation/dislocation* 1. retinaculum seperates from fibrocartlgenous ridge (most common) 2. fibrocartlagenous ridge seperates from fibula 3. Bony avulsion off fibula
Wolf-Parkinson-White Syndrome treatment
*Procainamide* (Short PR interval (< 0.12), delta wave, Symptoms can include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope)
Ruedi and Allgower is a classification for
*Tibial plafond fracture (Pilon Fracture)* 1. articular nondisplaced 2. articular displaced 3. articular displaced, comminuted
CPRS types (2)
*Type I (RSD)* induced by ST or bone injury *Type II (causalgia)* induced by nerve injury
how to fix a blue toe problem (5)
*Venous problem* -*elevate foot* (the rest below are also used in white toe syndrome) -lossen bandage -Twist K wire -Remove K wire -Remove dressing consider opening
Parkinson: akinesia vs dyskinesia
*akinesia*: Parkinsons specifically to lack of movement, such as loss of arm swing, but is also used to mean slowing (bradykinesia) or reduction (hypokinesia) in the size of movements. Akinesia affects mainly the hands or the trunk and walking." It's caused by muscle rigidity. Often begins in the legs and neck. These muscles become very stiff. When it affects the muscles of the face the individual adopts a mask-like stare *Dyskinesia*: small involuntary movements that are like small ticks. Tardive dyskinesia (TD), estimated to occur in 30% of patients treated with neuroleptics, encompasses a broad spectrum of hyperkinesias associated with exposure to these drugs.
when are Lines of Zahn found V/Q mismatch=
*before* death due to PE (alternativing red and pink lines) helps diagnose PE: V/Q mismatch= hypoxia-->respiratory alkalosis, dysnea, chest pain, tackypnea, tacycardia, death
Drugs that should be taken up to and including the day of surgery include which of the following? (8 of the following) beta blockers and pulmonary medications angiotensin II receptor blockers aspirin and vitamin E clonidine antiiarythmics diuretics ACE inhibitors calcium channel blockers nitrates digoxin statins colestipol Niacin fibic acid derivitives cholestramine oral DM meds
*beta blockers and pulmonary medications* angiotensin II receptor blockers aspirin and vitamin E *clonidine* *antiarythmics* diuretics ACE inhibitors *calcium channel blockers* *nitrates* *digoxin* *statins* colestipol Niacin fibic acid derivitives cholestramine *oral DM meds insulin only*
preferred abx for necratizing fascitis? (3/0
*beta lacatmase inhibitor*, *clindamycin*, *MRSA drug*
Torus fracture
*compression fracture* in which one side of the cortex buckles onto itself and causes microfractures while the opposite cortex remains intact
fragile X foot type? symtoms?
*flatfoot.* genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females. Affected individuals usually have delayed development of speech and language by age 2
Retractors -Handheld: 5 -Self-retaining: 4 -Finger: 6
*handheld*: Desmarres, Hohmann, Joseph hook (double skin hook), Kleinert Kurts (single skin hook), Ribbon *Self retaining:* Beckman Eaton, Heiss, Inge (laminar spreader), Weitlaner Finger*: Army Navy, Goelet, Langenbeck, Volkmann, Ragnell, Senn
wound dressing purpose: hydrocolloid? Film? Foam? Hydrogel? Alginate?
*hydrocolloid: maintain* moist while absorbing *Film: provides moist*, no absorbing *Foam: high absorbant*, care not to dry out wound *Hydrogel: rehydrate* dry wounds *Alginate: highly absorbant* and *hemostatic*
Morton Neuroma ultrasound
*hyperchoic* (watkins and AMPLE)
lidocaine toxicity primary vs severe symtoms (3) treatment (4). (initial symtoms affect CNS before CVS)
*hypotension, bradycardia-epi, decreased respiratory rate* TREATMENT: mainatin O2, Valium , atropine, epi
When are punitive (damages exceeding simple compensation and awarded to punish the defendant) damages awarded?
*intential torts* ( Fraud, misrepresentation, slander, libel and false imprisonment)
most common location for pseudogout?
*knee (50%)* followed by ankle, wrist, shoulder
high or low kVp is best to evaluate ST
*low kVp technique* is better for evaluating soft tissue. This is why a very low kVp is required for mammography.
attachments for tibialis posterior? function of TP at contact?
*main*: tuberosity of navicular, plantar 1st cuneform. *plantar*: 2,3rd cuneform, cuboid, 2-4 met bases, *recurrent:* sustentaculum tali function of TP at contact: decelerate pronation of STJ, anterior movment of tibia, internal rotation of tiba
best view to view CC coalition and *TN coalition* on xray
*medial oblique view* and lateral views
Anteromedial portal
*medial* to TA lateral to saphenous n.v (classically the first portal made)
indication for a weil osteotomy? Orientation of the cut?
*metatarsalgia.* dorsal-distal to proximal-plantar along the metatarsal shaft, angulated 30 degrees, with an attempt to be parallel to the weightbearing surface.
define Bloodborne pathogens? (7) what are not routes of transmission? (4)
*microbugs in blood or body fluids like hepatitis and HIV*: Semen Vaginal secretions Cerebrospinal fluid Synovial fluid Pleural fluid Peritoneal fluid Amniotic fluid *(vomit, sputum, saliva (unless in dental procedure) and feces are not)*
SER fracture
*most common and most common* stage of SER 1. AITF or Tillaux-Chaput or Wagstaff fx *2. Short oblique fib fx at syndesmosis* 3. PITFL or Volkmann fracture 4. transverse fx of medial mall or Deltoid lig rup
moa for therapeutic ultrasound
*piezoelectric effect*: apply electricity to certain crystals, they vibrate generating ultrasonic sound waves
bone healing:which one is associated with AO principles of fixation? which one allows micromotion? which one is preffered method of healing. primary bone healing? vs secondary bon healing? when does vone callus form
*primary (Intramembranous) : little to no callus formation*. Preferred require anatomical reduction and rigid internal fixation, harversian healing. Cutting cone: osteoclast cutting a path follow by osteoblast laying down new bones. Gap healing: <2 mm gap still consider primary healing, No micromotion. AO prinicples of fixation. Preffered method of healing vs *secondary (enchondral) : require bone callus formation*. Allows micromotion. 8 weeks. less desirable method of bone healing.
Give an example in podiatry in which we would see contact dermatitis due to someones shoes (2)
*rubber* found in toe box of most shoes *cement* used to bind shoes together
First line of therapy for plantar wart treatment? what are its SE (list 3)
*salycyclic acid* headache, ringing in your ears, stomach pain, vomiting, diarrhea; syncope feelings; shortness of breath; burning, dryness, or irritation of the skin
when is a combo of NSAID and colchicine indicated for gout vs not
*severe attack*, >1 joint, large joint *moderate attack* monotherapy
standard of error vs standard deviation
*standard error*: estimate of how far the sample mean is from the population mean. vs Standard deviation: degree to which individuals within the sample differ from the sample mean.
common causes for erythema nodules on shins (6)
*streptococcos* most common sarcoidosis TB leprosy UC pregnancy
what are the class I steroids (4)
- *Clobetasol propionate* 0.05% (Temovate) - *Halbetasol propionate* 0.05% (Ultravate cream, ointment, lotion) - *Diflorasone diacetate* 0.05% (Psorcon ointment) - *Betamethasone dipropionate* 0.25% (Diprolene ointment, gel)
2 examples in which a dose of steroid (prednisone) would suppress the HPA axis for up to 6-12 months and prevent sx unless pt is given 50-75mg hydrocortisone the day of the surgery? what amount of prednisone *doesnt* cause long therm HPA axis supression
- 7.5 mg/day for <1week prior to sx - >20mg for > 5 days (5mg prednisone for any perior of time doesnt suppress HPA)
beir block -time limit -mmHg above systolic needed
- <45 min -30mmHg above systolic
Charnley's steps of Closed reduction:
- Exaggerate deformity - Distraction - Reducing deformity - Immobilize.
most common cuase of lisfranc injury moa
- Indirect: from forced PF. 43% - *Direct: foot trapped. 57%*
Hypothermia EKG
- J OR OSBORN WAVES (right after QRS complex & amplitude and duration are inversely related to core body temperature) this J wave is right after the QRS- it does not flatten before the T - shivering artifact - possible atrial fibrillation (look at the Osborn wave on aVF in the image)
Ottawa rule for ankle sprain or foot pain (7)
- bone tenderness: along distal 6cm pf posterior edge of fibula or tibia - fibular or tibia tip - 5th met base - navicular - midfoot -Inability to WB/walk *4* steps in ED -Inability to walk right after injury
describe bremsstrahlung (3)
- e- slow down enough to change diretion as it pass by nucleus - this causes a loss energy as x-ray. - Bremsstrahlung makes up 70% of x ray production
Fentynal characteristics: 5
- fast onset - short duration - 80-100x more potent than morphine - 40-50x more potent than heroin - used like propofol as a hypnotic agent during anesthesia
how to size up a cane? elbows flexed? which hand is it held in?
- greater trochanter to ground -30 -held on good side
Neuropraxia
- nerve contusion resulting in conduction block that recovers promptly
-DKA? -DMI or DMII? -first line of therapy?
- severe insulin deficnecy causes extreme hyperglycemia (350-900 BS) -more commonly seen in DM type I -IV fluids
-how does alcohol affect a phenol matrixectomy? -who would you neutrilize it? (2)
-*dilutes it and washes excess phenol becuase they are both in the alcohol family* (it doesnt neutrilize it). polyethyl glycerol, NaOH: 10 %, acetic acid (vinegar)
complications of a Weil osteotomy (3)
-*floating toe* most common -flail toe (reoccurance) -sausage toe (tx with sterioid to break scar tissue)
anterolateral portal
-*lateral* to peroneus tertius but usually found by transillumination
Flexible pes planus treatment from distal to proximal
-1st Cun: Cotton -nav-1st,2nd cun: HOKE with TAL -nav-1st, TN: Miller, with PTT and spring lig advance -navicular: young (keyhole) of the TA -navicular tuberosity: Kidner, TP transplantation -TN: lowman, TA rerouted to calc -Sustentaculum: selakovich restrics STJ -posterior STJ facet raised: chambers raise w/ bone -posterior STJ facet: Baker inferior -Sinus tarsi: Grice and Green -Anterior calc process: Evans -lateral calc: Silver -Calc slide up: Gleich to increase CIA -Calc slide medial: Koustsogiannis
Plastmatic Inhibition phase of graft healing
-1st phase -first 1-2 days -graft absorbs nutrients but remains *ishecemic*
Inosculation phase of graft healing
-2nd phase - by day 3 -*capillary buds* make contact with graft
Angiogenesis phase of graft healing
-3rd phase -by day 5 -new *blood vessels* grow into graft -graft becomes *vascularized*
Accomodative vs Functional use of plastazote #
-Accomodative lower durometer (#2,3) -Functional higher duromoter polypropylene, subortholene
Axonotmesis? aka? does it allow for regeneration?
-Axon damage, -aka Wallerian degeneration, -yes
braces used for Metatarsus adductus (4)
-Bebax shoe (use after serial casting) -Wheaton brace (use instead of serial casting) pic -Wheaton brace system (as additional AK component) -IPOS shoe (also used for met head ulcers), its half a shoe with proximal sole intact
glomus tumor description? derived from? location?
-Benign, painful, red-blue tumor under the nails -arteriovenous shunt surrounded by a capsule and are involved in body temperature regulation
what are the branches proximal to the sural nerve
-Communicating ramus of the LSC joines -MSC
4 main type of plates? 3 specialized plates
-Compression plate (aka dynamic compression, static compression): slopped screw holes -Neutralization plate: (-) bending, rotation, axial loading -Buttressing plate: protect from compression or axial loading -Tension-Band plate: picture 1. Antiglide plate: oblique fractures 2. Bridge plate:bridges comminution 3. Locking plates: prevent toggle
What is necrobiosis lipoidica? (4)
-Diagnosed in 50% of DM pts -Chronic granulomatous dermatitis a/w DM -Can get the lesions BEFORE onset of DM -Most frequently on shins/dorsum of foot
-what tendon is involed with Jones Tenosuspension
-EHL W388
Giant cell tumor on radiograph
-Eccentric osteolytic lesion extending to the subchondral bone, -large extensive periostitis is not present, -the cortex can be eggshell thin
contraindications for wound vac (4)
-Exposed blood vessels, organs, nerves -Malignancy -Untreated OM -Necrotic tissue eschar
Express contract vs. implied contract
-Express: uses exlicit language -Implied: without verbal use (doc implyies payment with pt)
braces used to treat club foot (4)
-Ganely splint (controls RF and FF) -Denis Browne bar (bar is screwed/rivited to shoes) -Fillauer bar (bar clamps to shoes) -Uni bar (ball n socket under foot to adjust into varus -counter rotation (Langer) (has multiple hinges to address torsion)
most common forefoot fracture
-Hallux fracture
Podiatric surgical emergencies? (5)
-Infection with emphysema (gas gangrene) -Open fracture/dislocation -Compartment syndrome -Necrotizing Fasciitis -General Neurovascular compromises
Isometric vs Isokinetic vs isotonic which ones can be performed in a cast
-Isometric contraction (static contraction): muscle contraction not associated with joint motion or change in muslce lenght. can be preformed in cast -Isokinetic contraction: Contraction at a constant velocity at all ranges of motion by using a machine with an accommodating resistance. -Isotonic contraction: muscle contraction with assoicated joint motion and change in muscel lenght. Can be preformed in a cast
what/why can be given preopertivley for thyroid surgery (2)
-Lugol solution -Saturated solution of potassium iodide They *decrease* vascularity to the gland
augmented open primary repair achilles tendon -Lynn: -Silverskoid: -Lindholm: -Bug and Boyd: -V-->Y: -Ma and Griffith:
-Lynn: plantaris is fanned out -Silverskoid: 1 strip of gastroc and twisted 180 -Linholm: multiple strips of gastroc -Bug and Boyd: strips of fascia -V-->Y: lengthen proximal, with FHL -Ma and Griffith: percutaneus bunnel type
Fibrosarcoma features?
-Lytic tumor without osteoid or chondroid matrix. -May be permeative to a fairly well-defined area of lysis. -Tend to predominate in fourth decade. (30s) -May have a bony sequestrum.
Dennis Brown bar use (3)
-Metatarsus adductus -vertical talus -club foot
Conservative treatment for tarsal tunnel syndrome (3)
-NSAIDS -local PT nerve block with corticosteroids -orthotics to control pronation
Elements of full informed consent
-Nature of the decision/procedure -Reasonable alternatives -risks, benefits, and uncertainties for above -Assessment of patient understanding -Acceptance of the intervention by the patient
Cuboid abduction angle
-Normal = 0-5 -flat foot is increased
Non-absorbable suture (5)
-Nylon , -Proline . -Ethibond. -Stainless steel least rxn, -Natural Silk Great handling, "only poly g or d ar absorbable"
OFFLOADING: -Ossur Active Offloading walker -Bledsoe Boot -IPOS shoe -Orthowedge shoe -Reverse IPOS -Clamshell or Bivalve -MABAL shoes -Healing sandale -Multi podus bot -Football dressing
-Ossur Active Offloading: octogonal cushions -Bledsoe Boot: "CAM boot" to replace TCC -IPOS shoe: wedge shoe for forefoot ulcer, 10 degrees DF, with a 4cm lift -Orthowedge shoe: wedge shoe for forefoot ulcer -Reverse IPOS: wedge shoe for heel ucer, 10 degree PF -Clamshell or Bivalve: CROW to replace TCC -MABAL shoes: fiberglass cast with padding -Healing sandale: custom accomodative made with plastizote -Multi podus boot: aka L'Nard splint -Football dressing:volume of padding
all connective tissues assicated with tendon: epitenon, endotenon, paratenon, mesotenon. should be pereseved with tenond transfers 3. surroundings entire tendon, allows tendon to slide, supplies most of blood supply 4. attaches tendon to sheath, brings blood from paratedon to tendon 1. outer covering of a tendon withint its sheath, covers multiple fasicles. most important structure in tendon repair 2. loose acelluar tissue carring blood vessels that surround individual fascicles 6. cover a bunch of m. fibers which are bundled togeter by endotenon 7. smallest portion of tendon, tropocollagen, healthy fibers are composed of type 1 collogen
-Paratenon 4. Mesotenon 1. Epitenon 2. Endotendon 6. Fasicles 7. collegen fibers
-what formula is used for burn fluid managment? -Person 70kg male with burn to 25% of body, how much fluid to give?
-Parkland formula (body weight x amount burned x 4) = 70 x 25 x 4=7,000cc give 1/2 first 8 hours, give second 1/2 16 hours
-purpose for cole procedure? -how is the osteotomy?
-Pes Cavus -Dorsiflexory wedge osteotomy through the naviculocuneiform joint and cuboid W432
Depression Subtypes (5)
-Psychotic: mood-congruent delusions -Postpartum: w/in one month after birth -Atypical: weight gain, hypersomnia -Seasonal: fall and winter depression -Double: MDE in a dysthmic patient
Pancytopenia Causes (deficiency of all three cellular components of the blood (red cells, white cells, and platelets)) (4/8)
-Radiation/toxins toulene, DDT, benzene -Drugs: Sulfa, phenytoin, carbamazepine, chloramphenicol, EtOH, chemotherapy -SLE -PNH -Infections: HIV, hepatitis, CMV, EBV -B12 and folate deficiency -Thyroid-inhibiting medications such as PTU and -methimazole
surgical treatment for Eversion sprains (3)
-Schoolfied: deltoid lig advancement -DuVries: slash deltoid lig to increase scar tissue to strenght it -Wittberger: TP tendon passed through drill hole in distal tibia and reatached to itself
pyogenic granuloma, often confused with? age? commonly seen with? symtoms?
-Severe inflammation of the nail in which a lump of red tissue grows up from the nail bed to the nail plate, *confused with nodular melonaoma* -<30 years of age -pregnancy -no pain but can cause nail bed pressure pain and bleed easliy when touched
Sudeck atrophy radiographic findings? which CPRS stage is it associated with?
-Severe, patchy osteoporosis and soft tissue swelling (hands or feet) -seen with CPRS stage II
Anaphylactoid Reaction (3)
-Similar to anaphylaxis but occurs after 1st exposure -Does not require sensitization -Reactions have a dose-related toxic idiosyncratic mechanism rather than an immunologically mediated one
what are some ways the lower extremity compensates for equinus (5)
-Subtalar joint pronation -Unlocking the midtarsal joint -knee flexion -abductory twist -genu recurvatum -early heel lift
-Tillaux fracture (Chaput-Tilleaux) -Wagstaffe fracture -Volkman-Tilleaux fracture
-Tillaux fracture: SH III fracture anterolateral of distal *tibial* epiphysis. "T in tillaux, t in tibia" (pic) SER, PAB, PER -Avulsion off anterior *fibula* (anterior tib fib ligament "f in wagstaff, f in fibula" -Avulsion of posterior *tibia* (Post tib fib lig)
-EMLA cream use? -most serious SE?
-Topical anesthetic: used in circumcision -Methemoglobinemia (reduced O2 transport)
uses for white foam wound vac (4)
-Tunneling or tracking -Overlying bone or tendon -Over skin grafts -Highly sensitive pts
Tc-99MMA use
-acess capillary bed perfusion in DM -Acess healing potensial in ischemic ulcers
Absolute contrainidcations for Asprin (5)
-active wound or lesion hemorrhage -heprin induced thrombocytopenia and thrombosis (HITT) -warfarin use in pregnancy -severe trauma to head, spinal cord, or extremities with hemmorage in past 4 weeks -spinal or epidrual anesthesia
What is the talocalcaneal angle AP? more useful for cavus or flatfoot?
-aka kites angle:angle formed by the intersection of a line bisecting the head and neck of the talus and a line running parallel with the lateral surface of the calcaneus -seen on AP xray -normal is <25 *-flatfoot is >25*
Flexible pes cavus treatment from distal to proximal (7)
-all mets: DWFO -1st met-1st Cun: Mc Elvenny-Caldwell -all tarso mets: JAHSS -Nav-Cuns and Cuboid: Cole -V apex in Nav, med 1st cun, lat is cuboid: JAPAS -MTJ (choparts): DuVries -calc: Dwyer "COLE DUVRIES a mexican JAPAS washing his JAHSS in a CAVE and DWYERing it MCEVENNy saying DFWO"
5 findings on x-ray for OA
-assymetrical jt space narrowing -subchondral cysts -osteophytes -sunchondral sclerosis -joint mice -herberdens and bouchards nodes
how to draw Engles angle? normal? adducted foot?
-bisection of 2nd cunieform to the bisection of the 2nd met -normal: 24 -adducted foot: >24
lateral deviation angle for tailors bunion? 4-5 IM angle?
-bisection of 5th met in relation to medial cortex of met shaft: normal <3, >8 is abnormal normal IM 7. >7 is abnormal
-#1 tarsal fracture is in what bone -Lateral slip of plantar fascia inserts where? -Coalitions. which more common, posterior facet of T-C or C-N bar?
-calc -5th met head -CN bar
how does a Aneurismal bone cyst appear on MRI
-calcaneus -lobulated -multiseptated mass -varying signal intensitys
-screw with wider pitch is ment for cancellous vs cortical bone. -metallic components of a stainless steel screw (3) -of the 3 components, which is the major? -max harness of martensitic stainless steel screws
-cancellous -chromium (major component), nickle, molybdenum -97 HRB
when would a second dose of antibiotic needed to be given in the OR (3)
-cases longer than 2 hours -significant blood loss -Immunocomprimised pt Mcglammary 104
who is considered high risk for latex allergy (3)
-chronic urologic conditions -spina bifida -atopic dermatitis
in malpractice case, what types of damages are awarded (2)
-compensatory damages and -possibly loss of consotorium (deprivation of the benefits of a family relationship due to injuries caused by a tortfeasor)
cause of erythrasma? it often is confused with what?
-cornybacterium minutissimum stains woods lamp "coral red" -tinea pedis W242
brace for internal rotiation deformitie (2) vs surgical options for tibial torsion
-counter rotation (Langer) -Friedman counter splint or flexosplint (addresses torsion) derotational supramalleolar tibial osteotomy vs. proximal osteotomy
mechanism of injury for liz franc (2)
-crush -Plantarflexed Abducted foot
pathophysiology of Venous Insuffienciy
-desctruction of deep valves=reversal of blood goes from deep back to superficial.muscular action is innefective, superficial valves become destroyed creating increased pressure, fibrosis, pigmentaton, ulcers
example of mechanical hemostasis include? (8)
-direct pressure, compressive dressings -vessel ligation -bone wax (inhibits bone healing) -trouniquet application -acrylates -gel foam -topical thrombin
crutch training: -elbows flexed how many degrees: -Distance from axilla and armpit: -hand grip should be: -tip of cruch shoulde be how far from foot: -ascending stairs -descending stairs
-elbows flexed how many degrees: 30 degrees -Distance from axilla and armpit: 2 fingers (6cm) -hand grip should be: level of ulnar styloid process or level of greater trochanter -tip of crutch should be how far from foot: 6 in -Ascending stairs: Lead with good leg -Descending stairs: lead with bad leg
poor turgur
-fluid loss or dehydration pinch skin for a few sec and it doesnt rebound back
full thickness skin graft -thickness -encorporation -shrinkage -pigmentation -susceptible to trauma -fail rate -cosmetic appeal
-full thickness skin graft: -epidermis, dermis, appendages -slower incorporation, -less shrinkage -better cosmetic appeal -less suseptible to trauma -higher fail rate -better cosmetic appeal
Dorsum of the foot mass along tendon sheeth that trans illuminates? MRI T2/STIR? MRI T1
-ganglion -MRIT2/STIR: typically high signal -MRI T1 low signal (pic)
normal BNP levels? (B natrietic peptide) increased in what pathology?
-hormone released w/ strong heart contracting <100 (normal) -increased like at 900 with CHF,high blood pressure. lung infections, such as pneumonia
4 benefits of warming up
-increase HR -blood flow to muscles -activates B oxidation -prepare the mind
moa for local anesthetic? and what order are sensations lost?
-it binds reversibly to sodium channels and increases threshold for depolarization. -pain, temp, touch, propioception, sk muscel tone
-snowboarders fracture location? -moa? -whats the sign
-lateral process of TALUS -Dorsiflexed and inverted -V sign is disrupted
Treatment for DVT (6)
-leg elevated 15-20 degrees - bed rest -Lovenox (1mg/kg SC q 12) -monitor PTT -Coumadin for long term (10mg loading dose) -follow pt for 3 months
what is bohler angle? what is normal? calcaneal fracture?
-measures the ankle of superior calcaneus and the posterior factets of the calc -normal: 20-40 -calcaneal fractures: decreased "B below (decreased), its also Behind the foot in location" W474
osteopetrosis radiographic (3)
-medulla is complete destroyed- all bone is cortical so very brittle -Erlenmyere flask deformity -bone with in bone appearance (pic) "aka brittle bone disease"
obligations of doctor to his insurance carrier (4)
-notify promptly when a claim is received -cooperate with adjuster and defense lawyer -appear to court -submit deposition before trial
Obesity facts preop (3)
-obesity: lower mortality post op increase risk( DM, HTN, CVD, DVT -obesity increases intubation difficulty
Hyperparathyroidism on xray Review on PTH vs Calcitonin?
-osteopenia -brown tumor: holes in bone -salt and pepper" skull -rugger-jersey spine" -sup-periosteal bone resorption PTH (+) osteoclast to destroy bone and increase blood calcium levels Calcitonin (-) osteoclasts, it brings calcium from blood into bones
How is the Babinski reflex tested? normal?
-outer surface of sole stroked with blunt object from heel toward the small toe -normal reponse is toe flexion
Early radiographic signs of gout? most common gout type?
-periarticular swelling of joint margins -erosions of joint -punched out lesions -Gout spares the joint space. *underexcreter is most common*
where are all the secondary centers of ossification in the foot? (7)
-phalanges base (6mo-2yr) -1st met base (3yr) -met heads 2-4 (3yr) -posterior calcaneus (4-10yr) -5th met tuberosity (7-10yr) -lateral tubercle of talar body (8-9) -Navicular tuberosity (10yrs)
examples of chemical hemostasis (5)
-phenol -alumnium chloride hexahydrate -silver nitrate -dichloroacetic acid -trichloroacetic acid
What is Hibb's angle? best to evaluate what? normal vs abnormal?
-plantar calc and 1st met on lateral -normal: 135-140 *-cavus foot is >150* watkins or >45
ankle arthrodiastasis: -promtes what in the jointspace -lenght of ex fix -WB? -distraction lenght -best age to perform
-proteoglycan synthesis -12 wk -yes -5mm -20s-40s
risk factors for longtitudinal meloncychia (5)
-race:Afro-Caribbeans, -trauma, -systemic disease, -medications, -postinflammatory ie lichen planus
best treatment for deep frost bite (3,4 degree) (2)
-rapid thawing at tempuraures slightly above body temp. -Immerse body part in warm water 104-107 F until it has returned to normal temp (30 min)
best treatment for superfical frost bite (frost nip) (1,2 degree) (2)
-rewarmed by applying constant warmth - gentle pressure from a warm hand (no rubbing)
why get a CHADS 2 score? what does CHADS letters represent?
-score of 5-6 justifys bridging in pts with afib who are at risk of stroke
what is talonavicular articulation? normal angle? what angle is significant for flatfoot?
-see on AP xray -normal is <50% -60%-70% head is covered indicates flat foot
What is Meary's angle? flatfoot vs cavus foot?
-seen on lateral *talus and 1st met* -normal: 0 -flatfoot: 1-15 -cavus: >15 severe
common donor sites for full thickness skin graft (4)
-sinus tarsi -gluteal fold -popliteal fossa -inguinal area -flexor cressors
location for osteoblastoma (3) is it malignant or benign?
-skull -spine -diaphysis of long bones rarley malignant, but it is a rapidly forming tumor
what causes erythema nodosum 5
-strep infection (flu) -sarcoidosis -leprocy -Innflammatory bowel disease -pregnancy
congenital vertical talus -talus: -forefoot: -calcaneus: -hallmark of vertical talus Radiographic findings: -talus and tibia -kites -talar neck shape -navicular -hubscher maneuver
-talus: vertical -forefoot: AB/DF -calc: valgus, eqin (foot may even touch front of tibia at birth) -rigidy is a hallmark Radiograph: take bil and compare it with other foot in max plantarflexed position. -talus and tibia are parallel -Kites >40 -talar possible hourglass shape or flat surface -Navicular articulates with dorsal neck of talus -Negative
-A peroneal spastic block may need to be given to more fully evaluate ththe STJ ROM of what pathology? (they are the most common cause of peroneal spastic flatfoot) -If lower STJ axis closer to floor, you get more motion in which plane?
-tarsal coalitions -frontal
Absolute Contraindications for epinephrine use in surgery (5)
-thyrotoxicosis -CAD -PVD -Vasospastic conditions -tricyclic antidepressants
-Chronic compartment syndrome symptoms -normal m. contraction can have an IM pressure >50 but should decrease after 5-10 min. If it is 30mmHg for more than_____time=compartment syndrome
-tight calf pain that occurs with heavy exercise in athletes with large mass and is slowly releived with rest -30min
Vamp of a shoe includes
-toe box -throat (area where vamp, quarter and tongue meet) (throat=vamp in pic)
-Define tort? -Define Negligence -Tort law 2 types?
-tort=Injury -Neglegence: surgeon acted unreasonably under the circumstances that resulted in pt injury. It does not impply that the neglegence was intentional or on purpose. -1. Elements of negligence tort 2.Intentional tort
tarsal tunnel causes (4)
-trauma -Inflammatory conditions -Space occuping lesions -Biomechanics
what are the types of diabetes
-type 1 10% of DM -type 2 90% of DM -gestational diabetes
most common location of pressure ulcer for: -wheelchairbound -bedridden prone -lateral position
-wheelchairbound: ischium -bedridden prone: sacrum -lateral position: trochanter
why is it advantgeous to give a local proximal to a wound (3)
-wounds are acidic -locals are weak bases -the acidicy of the wound prontaes the local outside of the cell which doesnt allow it to diffuse within the cell and be effective
Oppenheim Test? postive sign indications
. Run fingernail down along anterio-medial line of the tibia. Positive if great toe extends and toes splay and athlete has hypersensitivity. Postive sign=UMN lesion
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deep tendon reflex grading
0 = no response 1+ = diminished *2+ = NORMAL* 3+ = increased 4+ = hyperactive
Eichenholtz classification stages of Charcot
0 foot warm, no xray findings 1 fragmentation 2 coalescence 3 Remodeling
SED (ESR) rate normal? infection, inflammation, malignancy?
0-30 increased
ESR
0-30mm/hr *rate at which erythrocytes settle out of anticoagulated blood in 1 hour. Abnormal values: mild 30-40 (infection) moderate 40-70 (OM) severe 70-150 Marker for infection
time frame to justify bridging
0-6 months preop of previous Venous Thromboembolism
normal compartment pressure in foot
0-8mmHg
stages for charco (4)
0. pre charco 1. Development, acute, fragmentation 2. Coalescene, fracture healing, debri resorption, new bone formation 3. Remodeling, inflammation diminish, rocker bottom foot,
K wire sizes (5)
0.028, 0.035, 0.045, 0.054 0.062
nerve sclerosing chemical amount injected
0.5 cc 4% alcohol
incidence of DVT post op foot/ankle sx
0.5-3.5 %
How are ulcers using the UTSA graded: 0A 1A 2A 3A B C D
0A-preulcer 1A-superficial ulcer 2A-deep ulcer to tendon and capsule 3A-deep ulcer to bone and articulation B-infected C-ischemic D-both infected and ischemic W266
Determining HR by measuring the distance b/t 2 consecutive QRS complexes
1 box= 300 2 boxes= 150 3 boxes= 100 4 boxes= 75 5 boxes= 60 6 boxes= 50
How much is in 15 cube centimeters of 2% lidocaine?
1 cube centimetier (1cc) 15cc=15ml
When to give abx before surgery?
1 hour preop
Less than _______% of all energy is converted to usable x-rays. ______% is dissipated as heat: oil is used to insulate and cool the tube
1% 99%
stages of pagets (4)
1. *Destructive*: increased Osteoclastic 2. *Combinded*: bone desctruction/turnover 3. *Sclerotic/osteoblastic*: thickened trabeculae, ivory appearance in bone, bone expansion 4. *CMalignant*: elevated ALK, Ca, hydroxproline
bone healing stages (4)
1. *Inflammation:* 48 hours 2. *Soft Callus:*days to 1-2 mo-fibrous/cartilage 3. *Hard Callus:* 3-4 mo 4. *Remodeling:* years
Ex Fix types (3)
1. *Simple*: half pin + bar rail, fx must be reduced properly, tract infection 2. *Modular pin fixator* half pin and clamp and universal joint. very versatile, allow adjustment in different planes. Complex and bulky, tract infection. 3. *Ring fixator (llizarov)*: pins through bone attach to circle or half circle fixator. Allow adjustment in all planes. Bulky, pin tract infection.
1. SANDERS classifies what part of calc fractures 2. based on what CT sections 3.most common associated vertebral colunm fractured with a calc fracture?
1. *posterior facet* (CT scan-gold standard to calc evaluation) Type I - Non displaced articular fx Type II - two part posterior facet fx Type III - 3 part posterior facet fx Type IV - Four part/comminuted fx A is lateral-> B-> C is medial - A/B divide posterior facet into equal 1/3s - C divides posterior facet from sus tali 2. *coronal and axial sections* 3. *L1*
1.How far away do you need to be for sterile field? 2.About to scrub into a case. What principle must be employed? → Time/brush ? Wet/dry ? Wet/gauze ? 3.Pt with RA on corticosteroid but doesn't get dose morning of surgery, what canhappen? 4.Ending benzodiazepine? 5.Gave digital block in office and now patient with flushing, difficulty breathing, itchy, what to do? 6. Patient with history of malignant hyperthermia which inhaled anesthetic is okay foruse? 7. Of all the inhaled anesthetics, which one is most safe for cardiac pts
1. 12 inches 2. wet to dry 3. hypotensive crisis 4. anything ending in "-am", others include *Chlordiazepoxide or Clorazepate* 5. Put tourniquet around toe 6. Nitric Oxide. A pt that has malingnat hypertemia should be cooled in iced saline (not ringer's) 7. Isoflurane
where are the 3 interossei ligaments of tarsometatarsl joints
1. 2nd met base---1st cun (lisfranc) 2. 2nd met base---3rd cun 3. 4th met base---3rd cun
4-2-1 rule for maintenance fluids for an 80kg female witha 1 L deficit for 24 hours post op? 3 steps to determine rate/hr.
1. 40 + 20 + 1( weight -20) 40 + 20 + 1(80-20) 40 + 20 + 60= *120ml/hr* 2. 120 x time 120 x 24= *2880ml* 3. 2880 + ml deficit 2880 + 1000= *3880ml* 4. 3880/time 3880/24=162ml/hr
Diagnostic for OA in the knee must have 6 characterisitics?
1. >50 age 2. morning stiffness <30 min 3. bony tenderness 4. bony enlargement 5. Crepitus with AROM 6. No palpable warmth other chacteristics: synovial WBC <2000. ESR <40 rh factor < 1:50
other than routine H&P what other 3 things need to be addressed with a trauma workup
1. ABCDEs of priarmy survey 2. Tetanus status 3. NPO status
1. Acetylcysteine 2. Activated charcoal 3. Atropine 4. Digoxin immune fab 5. Dimercaprol 5. Flumazenil 6. Methylene 7. Naloxone 8. Pralidoxime
1. Acetylcysteine for acetaminophen poisoning 2. Activated charcoal for most poisons 3. Atropine for organophosphates and carbamates 4. Digoxin immune fab for digoxin toxicity 5. Dimercaprol for arsenic, gold, or inorganic mercury poisoning (MAG) 5. Flumazenil for benzodiazepine overdose 6. Methylene blue for drug-induced methemoglobinemia 7. Naloxone for opioid overdose 8. Pralidoxime for anti-cholinesterase nerve agents
what is done in a choparts amputation do preent equinovarus deformity
1. Achilles tenotomy 2. Tibialis anterior tendon reatached through drill hole in neck of talus
stages of CRPS
1. Acute/hyperemic 2. Dystrophic (sudex atrophy) (spotty osteopenia) 3. Atrophic
1. Epidemiology def 2. Incidence def? study type? 3. Prevelance def? study type
1. Branch of medical science concerned with the incidence, distribution, and control of diseases that affect large numbers of people. 2. The number of of new cases (disease) developing in a specific time in which the population is at risk. (cases/specific date) *cohort* odds ratio 3. The number of cases (disease) divided by divided by total amount of people. in a specific amount of time like weeks or months. (cases/people). *cross sectional study*
Appropiate reason s to end a pt-doc relationship (5)
1. Breakdown of trust and respect 2. Patient fraud (drug seekers) 3. Serious threat of harm, inappropriate behavior, conflict of interest 4. Communication breakdown 5. Physician's practice too large
3 common options Kuwada II treatments
1. Bunnell (figure 8 or weve stich) "nn looks like sideways 8" 2. Krackow (Interlocking stich)- strongest 3. Kessler (box sticth) "kelso likes box cars"
top factors that lead to post op Cardiac complications (4)
1. CHF 2.Rhythm 3.Age 4.coronary dz
*cavus foot radiology* angles for the following: CIA? Hibbs? Meary? kites? Cyma line? bullet hole sign? stacking mets?
1. CIA (>30) 2. Hibbs agle (>150) 3. Meary angle (>15) 4. Kites (<25) 5. posterior cyma line 6. bullet hole sign 7. stacking the mets "CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.
1.Disease: -progressive distal to proximal muscle weakness below knee -muscle atrophy -foot drop -pes cavus -affects peroneus brevis (spares peroneus longus) -lower motor neuron disease 2.Which muscle is best to be used for transfer
1. CMT 2. Tibialis posterior
prosimal phalanx HAV procedure 1. Poximal akin 2. Distal akin
1. DASA 2. corects IPJ
what is the hibbs tenosuspension
1. EDL tendon slips are ditached from insertion, combined and reattached t the 3rd cuneiform or base of 3rd met 2. the EDB tendons are reattached to each EDL tendon (this releases the buckling force at the MPJ and elevates the forefoot)
Jones Tenosuspension tendon transfer (3 steps)
1. EHL tendon is transected and rerouted at the 1st met head medial to lateral. 2. The distal stump of the EHL tendon is attached to the EHB. 3. Arthrodesis of 1st IPJ W388
Types of Bone growth stimulators (3)
1. Electrical Bone Stim (implanted 6-8 mo) "right on the BONE: invasive" 2 Electric field bone stim (non-invasive) "general FIELD of bone: non-invasive -Capacitive coupling (alternating current) -Inductive coupling (magnetic field) -Pulsed Electromagnetic Field (induced e field -Combined magnetic filed (static magnetic field) 3. Ultrasound bone stim (non-invasive)
Flat foot surgical corection in Transverse plane (2)
1. Evans: open osteotomy of calc 1.5 prox to CCJ with insertion of bone graft 2. Kidner (remove navicular tuberosity and trasnplant tibialus posterior tenond under navicular)
name the tendon associated with procedure 1. Girdlestone procedure and def 2. Jones tenosuspension and indications (2) 3. Hibbs tenosuspension and indication 4. Heyman procedure 5. Anchovy
1. FDL: cut, split, wrapped around prox phalnx 2. EHL: flexible cavus, flexible PF 1st ray 3. EDL: cut and shoved into 3rd met base or cun. Equinus w/o claw toes 4. long extensors 5. tenon is rolled up as interpositional
hammer toe deformities: (3) -what muscle is affected? -what is the deformities? -what is most common?
1. Flexor Stabilization: (flexor fire earlier and longer) "stable flexor is a pro" -PT tendon unable to resupinate the MTJ and STJ during midstance or beginning of propulsion -*Pronated foot* 2. Flexor substitution: "sub flexor ruptured surae" -least common, -seen after a rupture of triceps surae -over aggressive TAL 3. Extensor substitution: (extensor fire earlier and longer) "Ex sub lives in a CAVe" -TA is unable to dorsiflex through swing so EHL ad EDL substitute during swing phase -Cavus -claw toe (Extensor Stabilization doesnt exist "Stable Ex is an oxymoron doesnt exisit)
flat foot surgical correction in calcaneus (3)
1. Gleich: Oblique osteotomy displaced anterior to increase calcanela incliation angle 2. Silver: Lateral opening wedge with graft 3. Koutsogiannis: medial slide calcenal osteotomy
3 categories of retractors: 1. Desmarres, Hohmann, Joseph hook (double skin hook), KleinertKurts (single skin hook), Ribbon 2. Beckman Eaton, Heiss, Inge (laminar spreader), Weitlaner 3. Army Navy, Goelet, Langenbeck, Volkmann, Ragnell, Senn Function of a McGlamry elevator
1. Handheld: 2. self retraction 3. Finger releases plantar adhesions
1. acronym for HIPAA? 2. what does HIPAA do for people 3. what does OSHA stand for 4. What term is required for regulated waste containers? 5. how long does medicare require to retain medical records?
1. Health Insurance Portability and Accountability Act: 2. make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs 3. OSHA: Occupation safety & Health administration 4. biohazard 5. 6 years after creation
surgical optiosn for MA treatment of kids >2 years old after conservative serial casting has failed (7)
1. Heyman-Herndon-Strong: Transmetatarsal base capsular release and TA release 2. Berman & Gartland: crescentic osteotomy of all met base, 6 mm distal to physis. 3. Steytler & Van Der Walt procedure: oblique lateral base closing wedge all met bases 4. osteotomy (abductory closing wedge) of all met. 5. Fowler: opening wedge of medial cun with bone graft 6.Peabody muro: excision of base of 2-4, osteotomy of 5th 7. Mccormick and blount: lapidus, osteotomy of mets 2-4, wedge resection of cuboid
head bunion procedures general indications: 1. Austin: cut angle? 2. youngswick: 3. Reverdin: 4. Reverdin green: 5. Reverdin laird: 6. Reverdin Todd: 7. Watermann 8. Watermann-Green
1. IM, 60 degrees 2. Metatarsus elevatus 3. PASA, 4. PASA,Preserves sesamoid 5. PASA and IM, 6. PASA and IM , plantarflexion 7. hallux limitus 8. hallux limitus, preserve sesamoid
base HAV procedures general indications 1. Cresentic: benefit 2. Trethowan 3. Juvara 4. Loison Balacesu 5.Logroscino
1. IM, short 1st metatarsal (doesnt shorten) 2. IM Open base wedge 3. IM Closing oblique base wedge 4. IM lateral closing base wedge 5. PASA and IM (reverdin + base)
pt presents to the ED and DKA is suspected, what is the correct order of treatments in order? (4)
1. IV fluids (collect BMP) 2. Na (1L 0.9% Na over 1 hour) 3. K ( confirm K is >3 before insulin) 4. Insulin therapy
Intraosseus type implants (3) (not used much anymore. . the rest would be extraosseus type
1. LSI (Lundeen Subtalar implant) 2. STA-peg (Peg subtalar implant) 3. Future ASI (angled subtalar implant
1. How do you officially end doctor patient relationship? 2. Triad of informed consent (3) 3. Is it okay to charge people for copies of their medical records? 4. What variable includes mortality and number who have disease?
1. Letter 2. justice, jurisprudence, benevolence 3. yes 4. relative risk
what are the 3 positions to fully visualize the STJ on xray (Isherwood)
1. Medial Oblique= anterior facet 2. Medial Oblique Axial= middle facet 3. Lateral Oblique Axial=posterior facet W202
1. Moncheberg Dz: 2. Arterioslcerosis obliterans ( ASO, Artherioscerlotic Occlusive disease) 3. Thromboangiitis obliderans
1. Moncheberg Dz: benign areriosclerosis from *calcification* to medium sized arteries. doesnt decrease blood flow and is an incidental finding on xray 2. *proliferation of intima* of small vessels completley occlude lumen leading to tissue ischemia 3. *inflammatory changes to small-medium* sized veins and arteris most often caused by tobacco
Neck HAV procedures general indications 1. Peabody 2. Hohmann 3. Wislon 4. DRATO (derotational ABductory Transposi Osteoto) 5. Michell
1. Neck reverdin to avoid sesamoids 2. PASA, IM, metatarsus elevatus 3. shortens and lateral displaces 4 place met head in any FRONTAL plane 5. IM, plantarflexes, lateral displacement
what are the 2 basic theroys for charco delopement?
1. Neurotraumatic 2. Neurovascular
1. aka Marble bone disease. No separation of medullary and cortex. Erlenmeyer flask: flaredmetaphysis, bone within bone. Tarda type is benign, adult. Congenita ismalignant, peds, brittle bone, multi fx. assicuated with hypoparathyroidism from infancy. 2. Define pseudohypoparathyroidsim, common locations occur?
1. Osteopetrosis (pic) 2. low serum calcium and high phosphate, but the parathyroid hormone level (PTH) is appropriately high (due to the low level of calcium in the blood). short 4th mets
4 reasons for hallux varus complication after bunionectomy
1. Overcorrection of Bunion deformity 2. Medial capsuloraphy over tightening 3. Staking of the Head 4. Removal of Fibular sesamoid
what are the phases of graft healing? (3) same for both partial and full thickness
1. Plasmatic Inhibition phase 2. Inosculation Phase 3. Angiogenesis Phase
subtypes of Juvenile Rheumatoid arthtiris
1. Polyarticular (40%) 5 or mor jnts 2. Pauciarticular (40%) (iridocyclitis) 4 or less jnts 3. Systemic (20%) still disease
There are 3 levels of disease prevention what level if podiatry?
1. Primary Prevention - trying to prevent yourself from getting a disease. *2. Secondary Prevention - trying to detect a disease early and prevent it from getting worse.* (podiatry) 3. Tertiary Prevention - trying to improve your quality of life and reduce the symptoms of a disease you already have.
fixation order for triple (6)
1. Resect MTJ (CC then TN) to allow access to STJ 2. resect STJ 3. Temporay fixation STJ 4. Temopary fixation MTJ (CC then TN) 5. Fixate STJ 6. Fixate MTJ
high yield contraindications for use of epinephrine in surgery? (6)
1. Sever PAD 2. Severe HTN 3. Hyperthyroidism 4. Pheochromocytoma 5. Tryciclicn antidepressants (MOA inhibitors) 6. Vasospastic conditions
1. Where are STJ arthroeresis implants inserted? 2. how does it work? 3. aka
1. Sinus tarsi between posterior and middle facet 2. limit pronation and reduce heel valgus by blocking contact of lateral talar process against the calcaneal sinus tarsi floor 3. aka "implantable orthotic"
Port-Wine Stain (Nevus Flammeus) associated with what 2 syndromes
1. Sturge-Weber syndrome (pic) 2. Klippel-Trenaunay-Weber syndrome
What are semi-rigid shell materials
1. Suborthelen 2.Polypropylene 3.Orthelen 4. Carboplast
Lauge hansen PAB stage
1. Transverse fracture of medial mall (below syndesmosis) or rupture of deltoid lig 2.Rupture of anterior inferior and PITFL or Tillauex-chaput or wagstaffe frag 3. Transverse or comminuted fracture of fib at level of syndesmosis (lateral spike)
Lauge hansen PER starting stage
1. Transverse fracture of medial malleolus or rupture of deltoid ligament 2. rupture of anterior syndesmosis and rupture of interosseus membrane or Tillaux-Chaput fragment or wagstaff 3. spiral fx above level of syndes mosis, maisonneuve fx 4. posterior talofibular lig rupture or fracture of post malloelsu. large frag
triad for tetanus symtoms
1. Trismus (lockjaw) 2. Risus Sardonicus (sustained m spasm) 3. Aphagia (cant swollow)
1. cardiac catherization lab use 2. Cardiac stress testing use 3. Cardiac nuclear scanning
1. Used to evaluate the heart and blood vessels around the heart and lungs 2. Diagnose CAD. symtoms chest pain, shortness of breath....consistent with MI symtoms 3. advanced tool to diagnose CAD
Post-op Fever 5 W's, time frame, treatment
1. Wind 24-48hr: pain control, incentive spirometry 2. Water: day 3 due to urecholine, straight cath 3. Wound: day 5 4. Wonder: cany happen any time due to:Drugs anesthesia 5. Walking: day 7-10 due to not walking.
1. define tort 2. what is the inurement prohibition
1. a private not based on contracts 2. The inurement prohibition forbids the use of the income or assets of a tax-exempt organization to directly or indirectly unduly benefit an individual or other person that has a close relationship with the organization or is able to exercise significant control over the organization.
Lateral release for Bunionectomy order: (4)? which step has the risk of hallux varus?
1. adductor tendon 2. fibular sesmoidal lig 3. lateral head of FHB 4. remove fibular sesamoid (AE is hallux varus, should only be done if previous 3 steps of the release do not give adequate correction)
name the true AVNs (5)
1. capital frag of femoral epiphysis in kids 2. Talus 3. Navicular 4. Met heads 5. Sesamoids (trevors and randiers)
1. Which gives strength to wounds while healing
1. collogen
what needles when suturing skin (2)
1. conventional cutting 2. reverse cutting (pic)
Triad for haglunds deformity that can be seen on MRI t2
1. distal insertional achilles tendonopathy. 2. Retrocalcenal bursitis, 3. retro achilles bursitis
what are the elements of malpractice? (4)
1. duty 2. breach of duty 3. damage 4. causation: causal relationship b/t breach of duty and damage (proximate cause)
3 phases of technetium bone scan/ time frame
1. dynamic blood flow. 3 sec interval 2. blood pool. 3 min 3. bone imaging. 3 hours 4. delayed. 24 hours to allow for clearance)
Valmassy's rule of 7 (2) what if the kid is still everted at 7 years old?
1. early walking child should have *maximally everted calc of 7 degrees* 2. by age 7 the calc should be *perpendicular to the ground* (if kid still has max everted calc of 7 degrees= pediatric hyper mobile flatfoot)
3 types of tailor's bunion
1. enlarged head 2. increased lateral bowing angle >8 3. increased 4-5 IM angle. >7
degrees of burn? (4)
1. epidermis 2. epidermis/partial dermis 3. subcutaneus tissue (full thickness) 4: underlying muclse W493
1. mechanism of injury for distal tibiofibular syndesmotic injury (3) 2.how to clinicaly illict pain with a syndesmotic injury 3. clinica tests for syndesmotic injury (3) 4. normal tibfib overlap >10mm, Tib clearspace <5-6mm, medial clearspace <4mm should be on what type of radiograph 5. 4.5 syndesmotic screw through # corticies? is the screw removed after 4 months?
1. eversion, dorsiflexion, pronation 2. Dorsiflexion ankle as anterior portion is wider, POP to syndesmosis 3. clinical tests -External rotation test (aka Kleiger test) pain with dorsiflexion and external rotation. -Distal compression test: medial compression of malleoli -Squeeze test: (aka hopkins test): proximal compression, can also do with crossed leg test does the same thing 4. tib/fib overlap: AP, tib/fib clearspace and medial cleaspace on AP or ankle mortice 5. 4 corticies, yes
hammertoe release steps (5)
1. extensor expansion release 2 EDB, EDL tenotomy/lenghtening 3. transverse MPJ capsulotomy 4. collateral lig release 5. plantar plate release with Mc Glamry scoop
3 most common causes of HAV
1. female 2. long first met 3. oval or round first met
first, second, third step in *high energy pilon fracture* (Plafond fracture, is a fracture of the distal part of the tibia,) is to stabilize:
1. fibular fracture 2. tibial plafond 3. medial mall fracture
Order for mal practice (5)
1. filling a complaint 2. doc contactacs mal practice insurance 3. Discovery 4. Settlement 5. Trial or Arbitration
-purpose for Jones Tenosuspension procudure (2)
1. flexible cavus foot, 2. flexible plantarflexed 1st ray
#1 and #2 reason for graft failure? other reasons?
1. hematoma 2. Infection -seroma (major complication from split thickness grafts) -shearing -poor wound bed
1. pPin and SnNout 2.high specificity vs high sensitivity
1. high specificty=Rule In high sensitivity=RO 2. good diagnostic test. vs good screen test
1. cannula ankle scope 2. trocar ankle scope 3. Obturator
1. hollow tube to maintain portal and put instraments through 2.sharp rod placed in cannula to pierece ST and capsule 3. same as trocar but blunt used to penetrate the joint
Triad for fat embolism
1. hypoxia 2. neurological abnormalities 3. etechail rash
define anemia (3)
1. increased RBC desctruction 2. decreased RBC production 3. blood loss
1.clubfoot radiograph: (3) 2.Simons rule of 15s 3. Beatson and Pearson Assessment method 4. when casting for club foot position of knee, -size of cast material, -lenght of ponsetti casting, -when to consider surgical treatment
1. kites angle: decreased -CI: decreased -Talar head/neck relative to body: increased adduction and plantarflexion 2. age <3 years -> *talo-nav subluxation*: if "MEARY flys a KITE with SIMON" kites = <15 degrees. mearys angle = >15 degrees 3. if sum of CIA and Kites is <40 degrees=foot is clubbed 4. 75-90 degres, -2 inch, -till age 4 -if no improvment in 12 weeks consider surgical
joint measuring: axis, moving arm, stationary arm 1. Ankle DF/PF 2. Ankle inversion/eversion 3. STJ inversion/eversion 4. 1st MTPJ Flex/Ext
1. lateral mall, 5th met base, shaft of fibula 2. anterior ankle, shaft of 2nd met, tibial crest 3. Posterior ankle, lower 1/3 of leg, bisection of calc 4. Medial 1st met head, proximal phalanx, 1st met shaft
1. AVN of the distal tibia? 2. AVN of the proximal fibular head 3. AVN of the 1st met head
1. lewin dz 2. Ritter dz 3. assmann dz
indication for benzodiazapines (6)
1. light anesthesia conscious sedation 2. seizures 3. alcohol withdrawl 4. Parasomnias 5. anxiety disorder 6. panic disorder *Do not provide analgesia*
1. Hilgenreiner line 2. Perkin line 3. Quadrant dislocated hip 4. Acetabular angle 5. Shenton line
1. line connecting most infer portion of acetabulum 2. draw a line perpendicular to helgenreiner lign at the outer most aspect of acetabulum 3. dislocated hip shows femoral head in outside upper quadrant 4. (pic) normal 27-30 at birth and decreases by age 2. >30=dislocated hip 5. contintous semicircle with femur and acebabulum
General anesthesia has 5 components
1. loss of conciousness 2. anlagesia 3. amnesia 4. m relaxation/lack of movement 5. blunting autonomic reflexes ie HTN, tachycardia
1. greenstick fracture. 2. which side is best to put a plate
1. mainly seen in children due to soft bones concave side remains intact convex side is fractured 2. convex side W464
the tibial nerve divides into what 3 branches beneth the flexor retinaculum"
1. medial plantar n 2. lateral plantar n 3. medial calcaneal n
Capsulotomines: -which ones are both transverse and frontal plane corrections? -which one is strongest medial capsolotomi 1. mediovertical 2. medial U 3. medial H 4. Medial T 5. Inverted L 6. Washington monument 7. Lenticular
1. mediovertical 2. medial U: transverse plane correction 3. medial H: transverse plane correction 4. Medial T: transverse plane correction 5. Inverted L: transverse plane correction *6. Washington monument: frontal and transverse-strongest *7. Lenticular: frontal and transverse*
Most common tarsal coalition
1. middle facet STJ 2. CNJ 3. TNJ
Shaft HAV prodecures general indications 1. Kalish 2. Scarf 3. Ludloff 4. Mau 5. Lambrinudi
1. modified long arm austin. NO PASA correction 2. IM 3. IM (dorsal proximal to plantar distal) 4. IM (dorsal distal to plantar proximal) 5. primus elevatus with closing PF wedge
1. Tensile strength is a measure 2. Anesthesia level of consciousness for surgery
1. of the time it takes for suturing material to lose 70% to 80% of its initial strength 2. 3
expert whitness function (2)
1. opionion on proximate causation (injury related to cause) 2. opinion on standard of care
1. Positive Ortolani Sign 2. positive Barlow sign 3. Anchor sign 4. Galeazzi sign aka Allis sign 5. Abdution test 6. Nelaton line 7. Gowers sign 8. Trendelenburg sign 9. Ryders test most of dislocated hips are which side?
1. palpable click felt as femoral head is made to enter acetabulum "O for already Out" 2. dislocates an unstable hip 3. more gluteal folds on dislocated side 4. dislocated hip has a lower knee position 5. dislocated hip has limited ab of affected side 6. greater tip is palpable distal to line=dislocation (pic) 7. seen in muscular dystrophy, kids must use knees and hands to get up 8. indicates weakness in the hip abductor muscles consisting of the gluteus medius and gluteus minimus. 9. trochanteric prominence angle test and the Craig's test, is used to clinically estimate the magnitude of femoral torsion or anteversion left (60%)
Type of wound closure
1. primary-immidatley sutured, must be clean 2. secondary-infected or dirty wounds left open to allow granulation 3. delayed primary-infected or dirty wounds left open for days or weeks then later closed with sutures after infection is gone
indcation for barbituates (2)
1. rapid induction of anesthesia (30 sec) 2. treat seizures (2nd or 3rd line use though)
Steps to treat a calc fracture
1. reduce Lateral extensile incision (hockeystick) 2. anterior calc 3. reduce posterior tubercle fragment use as a joystick to get good height 4. reduce lateral fragment 5. fixatate lateral wall and fixed with screws, plates
purpose for posting on orthotic (3)
1. reduce compensation 2. matche FF to RF 3. prevent rocking
2 types of fracture blister?
1. serous/clear fluid blister with tense roof 2. hemoragic fluid blister with flaccid roof
flap phisology terms (4) 1. change in length divided by original lenght of tissue where force is applied 2. force over cross sectional area. 3. increase in strain when skin is under constant stress. occurs in minutes due to extrusion of fluid from dermis and a breakdown of dermal framework 4. decrease in stress when skin is held at tension at a constant strain for a given time. occurs over days and is due to increase skin celluarity and permanent stretching of skin components
1. strain 2. stress 3. creep 4. stress relaxation
1. In a six-month-old child, aggressive casting for the equinus component of a clubfoot deformity may result in which of the following conditions? 2. most common complication with correcting clubfoot with serial casting whcih is due to correcting the equinus before the other 3 steps 3. Why is Equinus the last step in cub foot correction?
1. subluxation of the midtarsal joint 2. rocker bottom deformtiy 3. not cause excess dorsiflexion of the forefoot causing the rocker bottom deformity
1. Ankle scope, which nerve is most likely in danger? 2.How to avoid floating toe in Weil? 3. 5 th met fracture after non-union in 26 year old college student, how do you treat? 4.Best treatment for giant cell tumor in tibia? 5. Bone graft with fully threaded screw from far to near cortex through graft too, function of screw?
1. superficial peroneal (intmediate dorsal cutaneous is most common injury) 2. plantarflex it 3. Intramedullary screw 4. Curettage and phenol 5. Buttressing
at are the types of melanoma (4)
1. superficial spreading (most common) 2. nodular (worse prognosis) 3. Letigo (face or sun exposed, freckle) 4. acral (hands and feet)
3 movment terms for ankle scope
1. sweeping: side to side, up and down 2. Pistoning: magnification 3. Triangulation:bringing scope and other instruments together for orientation
Lag technique for a 2.7 cortical bone scew
1. threadhole (underdrill, far cortex) 2.0mm= core 2. glidehole (overdrill, near cortex), 2.7mm 3.countersink 4.Measure 5.Tap 2.7mm 6.flush 7.Screw 2.7mm
2 types of metal options for screws
1. titanium 2. stainless steele
mycetoma triad? most often occurs in which climate? most common site on body? bugs? (2)
1. tumefacation (becoming swollen) 2. draining sinus 3. colonial graines in exudates tropical countires hand repeated trauma allows micro to invade 40%-eumyceoma (fungi) 60%-actinomycetes (bacteria) *not a paracytic infection*
fixation sequence (6)
1. underdrill aka thread hole, Pilot (cortex to cortex) <than screw 2. overdrill aka Glide hole: same size as screw 3. countersink: to evenly distribute the force of the head of the screw, eveny purchase the bone, avoid soft tissue irritation 4.measure 5. tap 6. scew
1. zyngodactyly 2. synpolydactyly
1. webbing of 2nd and 3rd (most common) 2. one soft tissue mass covering 4-6 toes (pic)
Posterior-Lateral portal
1.0-1.5 lateral to achilles at level of distal tip of lateral mall (sural n, lesser saphenous v, peroneal tendons all should be lateral)
minifragment screw set (3)
1.5, 2.0, 2.7 W359
options for scope size and viewing radius
1.7, 2.2, 2.7, 3.5, *4.0mm* 0-90 (*30 degrees*)
Lauge-hansen SAD stages
1.rupture of lateral collateral ligament or transverse lateral mall fracture below syndesmosis (Danis Weber A) 2. Vertical medial malleolar fx
Increased SID by a factor of 2: distance increased by 2 = ???intensity?
1/4 i=1/d^2
distance x3= intesnity
1/9
Dorsiflexion and plantarflexion required for gait
10 DF 20 PF
Antibiotic coverage length for ST
10-14 days
Inflate ankle vs thigh tourniquet to what over systoilic
100 over if ankle 200 over if thigh
hydrolization of polyglycolic acid (dexon suture)
100-200 days (4-6 months)
Low Density Lipo protein (LDL) manegment goal in pts with PAD
100mg/dL
Ankle tourniquet should be set at ______mmHg higher than systolic? Max Tourniquet time
100mmHg (Ankle tourniqet should be on less time than thigh). 90 min
average human cadence
101-122 steps per min (women have faster cadence than man)
STJ range of motion required for gait
12 degrees
Define HTN
140/90 with 2 or more readings
DP foot xray: angle and beam focus
15 or 0, 2nd met base
Fusion position for a 1st MPJ position
15-20 dorsiflexion 10-20 abduction
Fat pad normal
15-23mm
durometer measurment comparrison: lowest? highest?
15: poron 15-20: #1 plastazote 35: #2 plastazote 45-65: #3 plastazote 25-65: Dthyl Vinyl Acetate 55-60: Cork 100: Polydur
Normal Toygar's skin angle
180 decreases with achilles tendon tear
Abx treatment for Gustillo and Anderson Types 1,2,3ABC
1: Ancef 2:Ancef and Clindamycin or gentamycin 3:A,B,C Ancef, Clindamycin or gentamycin and Aminoglycoside. (add PCN to any option if there is a fear of anaerobic or if there is a soil contamination farm injury)
List the following events in order that lead to formation of HAV?
1: STJ over pronates 2: MTJ unlocks-forefoot moves lateral 3: adductor hallucis pulls hallux and sesamoids 4: base of prox phal and sesamoids move lateral 5: angular retrograde force on 1st met->met moves medial 6: adductor hallucis is taut: pulling ligaments 7: bony proliferation on met head 8: EHL and FHL now have advantage: pull hallux laterally even more
WATSON-JONES classifications
1: avultion fx of tuberoisty of navicular 2: dorsal lip fracture 3: body of navicular (runners 4-5 days pre marathon)
how many extracapsular ligaments lateral ankle
1: calcanealfibular ligament
most common type 1 rowe
1c (bifurcate lig avulsion)
1st plantar common digial br of MPn innervates
1st Lumbrical
clost kinetic chain: 1st MTPJ First ray Midtarsal joint STJ Talus Ankle joint Tibia knee femur os coxa
1st MTPJ: dorsiflexed First ray: plantarflexed Midtarsal joint: pronation, maximally pronated STJ: supination Talus: dorsiflexed and abducted Ankle joint: dorsiflexed Tibia: external rotation knee: extended femur: external rotation os coxa: higher and posterior roated
what are the heart blocks? which heart block is most likely to be fatal?
1st degree 2nd degree -Mobitz 1 aka Wenckebach (progressive lengthening of PR until dropped QRS) pic -Mobitz type II (Dropped beats without progressive lenghtoning) *3rd Degree* (complete)-lyme disese (most likely to be fatal)
PR interval is prolonged >200msec, benign and asymtomatic, no tx required
1st degree AV block
commonality of neroma locations
1st most common: Morton 2nd most common: Hauser (2nd interspace) 3rd most common: Iselin 4th most common: Heuter 5th most common: Joplin
how is lauge hansen classified
1st word position of the foot, 2nd position of talus in relation to tibia
Crevice Corrosion
2 metals move against each other
discontinue MTX preop
2 weeks
statute of limitations makes you keep radiographs for up to
2 years but most states recommend keep them for 3 years and medical records for 7 years
statue of limitations: adults vs pediatric
2 yr is the limit to file a claim. But with pediatric, there is no statue of limitation
which of the jahass classifications *can* be closed reduced
2,3
Therapeutic range fo warfarin for INR half life of warfarin? half lief of heperin and lovenox?
2-3 40 hrs (vs heperin and lovenox of 1-6 hours)
how much shortening is expected in talectomy
2-3cm
distance External fixators should be from skin
2-3cm to allow for swelling
PMMA beads Abx to cement ratio
2-4gAbx:40g cement
IDSA treatment for bone/jnt infection with *removal* of infected bone, but residual ST infection
2-4wk IV or oral:
IDSA time frame guideline for residual infection (4)
2-5 d IV or oral: bone/jnt infection *without residual infection* 2-4wk IV or oral: bone/jnt infection with removal of infected bone, *but residual ST infection* 4-6 wk IV: bone/jnt infection with *residual infected but viable bone* >3mo IV: bone/jnt infection with *residual bone infected that is necrotic*
IDSA treatment for bone/jnt infection *without residual infection*
2-5 days IV or oral
how long does bupivacaine last
2-8 hours
strenght of PMMA beads over IV abx
200x
normal metatarsal declinication angle vs normal calcalneal inclincation angle
21 vs 20-25
disarticulated met lenght
23541
how soon after technetium should gallium be given in bone scan where is gallium extreted?
24-48 hours after technitium Kidneys
head tube angulation for calcaneal axial projection
25 from vertical
if a subungal hematoma is presents what is the likleyhood of an underlying phalanx fracture
25%
If the nail involves _______% must be removed to assess for nail bed laceration
25% or more of the bed,
Medial oblique foot projection xray: angle and beam focus
25, 1st met base/cune/navicular
Axial calcaneus oblique foot xray: angle and beam focus
25, posterior dorsum of calc
Talar torsion angle
25-30
how many degrees does hip flex at contact in gait
25-35
PTT (partial thromboplastin time) vs PT (prothrombin time)
25-35 sec (monitors speed of clotting with medication use ie heparin). vs 11-13 sec (time it takes to clot) warfarin will increase PT. (increase time=increases PT)
most states require lead aprons_____mm thick
25mm
normal MCH (mass)
27-31 pg/dl
Rowe Beak fracture
2A
Rowe classification for "Beak fx vs "tongue fx"
2A: beak (posterior superior calc body) "letter A looks like a sideways beak" (pic) 2B: tongue (achillies avulsion fx) "B bite your tongue"
Rowe tongue fracture
2B
how much supinatory moment across the STJ
2mm-6mm max
When excising a neuroma, patient 4th digit is laterally deviated. What was cut?
2nd Plantar interossi deep br of lateral plantar n
EKG dx: Progressive lengthening of PR interval until a beat is dropped (a P wave not followed by a QRS complex (asymtomatic)
2nd degree AV block aka Mobitz I aka Wenkeback "going going gone"
order of fixation for lizfranc treatment?
2nd met 1st met 3rd-5th met
how to change mAs with dry plaster
2x
chopart amputation was a high risk of more proximal amputation at ____years
3
if bone needed for the OR is dropped on floor, what needs to happen to clean in
3 consecutive soaks in betadine for 15 minutes
Gustillo Anderson Type III, if a bone graft is required for repair its best done how many months after reactive bone callus has diminished
3 months
3 weeks after an injury the tensile strenght of the wound is what % range of normal skin? vs months after an injury the tensile strenght of the wound increases to % range of normal skin?
3 weeks: 20-30% months: 70-80%
Xeroform ingrediants
3% Bismuth Tribromophenate in a petroeum base
if at least _____#_____ employes are hospitalized or die, OSAHA requires this to be reported to the nearest OSHA office
3+
for every ____mm of shortentin of the first ray, there is ____mm of elevation
3, 1
estimated time frame to allow demarcation of a frost bite pt
3-5 weeks
Talonavicular coalition age group calcaneal navicular bar age group Talocalcaneal coalition age group -most common? -extra articular? -Cowell procedure is indicatied for which? -least common? -most asymtomatic? -which coaltion has an absence of CC joint?
3-5 yrs "TN is simply 3-5" *least common* *most asymtomatic* 8-12 yrs "cn kind of looks like a sidways 8" *extra articular* *codwell procedure*: placing EDB muslce belly in void of resected coalition 12-16 yrs "TC is complicatied 12-14 *most common* (pic) CC coaltion has absence of CC joint
coalitions age: 3-5? 8-10? 12-14?
3-5: Talonavicular (TN) "TN is simply 3-5" 8-10: Calcanealnavicular (CN) "sideways figure 8" 12-14: Talocalcaneal (TC) "TC is complicatied 12-14"
1 MET=
3.5 ml O2/kg/min
normal MCHC (concentration of Hb of packed RBC)
32-36 g/dl
articulated met lenght
32145
what is a "LAST" refering to shoes
3D modle of shape and cubial content of shoes that shoe is built around
CT: Voxel: 3D vs 2D box= slice thickness of
3D: 0.15-2 cm. vs 2D 0.15-0.3cm
Between what layers does the DTML lie?
3rd and 4th layer (6) Interossei (7) DTML (12) lumbrical
lyme disease and heart block relation
3rd degree (complete)
pts able to walk a flight of steps w/o SOB are considered what MET
4 MET functional capacity
IDSA treatment for bone/jnt infection with *residual infected but viable bone*
4-6 wk IV
when to treat Metatarsus adductus surgically? soft tissue surcigal corrections for MA (4)
4-6 years of age (after failed conservative) Heyman, herndon, and strong thompson procedure lange lichtblau
Glasgow Coma Scale 3 categories and sub categories
4. eye opening: none, stim, verbal, open 5. verbal response: none, imcomp, innap, confuse, normal 6. motor response: none, decerebrate, decorticate, withdraw, localize, normal <7 poor prognosis >13 good prognosis
toxic dose of lidocain per kg
4.5 so a 70kg person was a lidocaine toxic dose of: 70 x 4.5= 315
large fragment screw set (2)
4.5, 6.5
Harris beath foot xray: angle and beam focus? where is the posterior facet in relation to the middle facet?
40 or parallel to posterior and middle facet.
Lateral oblique foot xray projection: angle and beam focus
40, 4th met-cuboid articulation or 3rd met-cun
minimum pressure recommended for compression stockings for treatment of lymphadema
40mmHg
whole blood shelf life
42 days (6 weeks)
what makes up the 4th ray of the foot? what makes up the 5th ray of the foot?
4th and 5th mets with thier respective phalangy
most common location for brachymetatarsaia
4th met
If the 3rd Lumbrical was cut on a right foot how would which toe deviate?
4th toe would flex
Decrease SID by a factor of 2 (distance decreased 1/2)
4x intensity
discontinue NSAIDS preop
5 days
Clark cancer staging
5 stages"clark explores layers" layers of skin 1 epidermis only 2. dermis/papilary dermis 3. entire pappilary dermis 4. reticular dermis 5. fat
-History of 8 weeks ago inversion ankle sprain, pain with walking and pushing off,which structure was hurt?
5 th met base injury
ossification of calcaneus
5-6 mo fetal development
Oral Vitamin K comes in what size tablets in the United states?
5-mmg (most common form of vit K is oral)
Steinmann Pin sizes
5/64, 7/64, 9/64 3/32, 5/32 1/8 3/16
m/c synotosis
5th DIPJ
4 most common coalitions in order
5th DIPJ STJ CNJ TNJ
time frame for the arthritis part of reactive arthritis? most common age and sex?
6 weeks, 25-35years old male.
# angiosomes in foot, fed by which 3 a? what is a choke vessel
6, anterior tib. posterior tib. peroneal a., unify network angiosome borders with blood.
how many hours should a pre op be NPO status
6-12
>20mg of corticosteroid therapy for >5 days can affect the HPA for how long? treatment for day of surgery
6-12 months 100mg hydrocortisone or double regular dose. day of surgery.
ossification of talus
6-7 mo fetal development
when is an open fracture considered infected?
6-8 hours post injury if no treatment is started
Normal IM angle for 4th and 5th vs normal lateral bowing of angle of 5th
6.4-9.1 vs 2.64
1/2 life for T-99
6.5 hours
degree of z plasty for most lengthening? difference between a hauser and White TAL
60 hauser: section post 2/3, prox/medial 2/3 white: sectio anter 2/3, distal/medial 2/3
% of pts that have dermatological psoriasis also get psoriatic arthritis
7%
how long does it take for the entire platelet pool to be replaced
7-10 days
whats the elution rate of typical antibiotic beads
72 hours
1/2 life for gallium
78 hours
NPO status preop
8 hours NPO allowed clear liquids 2-4 hours preop
when to stop smoking preop
8 weeks preop (more advantagous than not stopping or stopping <8 weeks preop
normal Ca value
8-10
normal MCV (volume of 1 RBC)
80-100
most commonly concentation of phenol used in matrixectomy
89%
probing to bone has what % positive predictive probability of OM
89%
treatment for Met addcutus manipulation and serial casting age? ST procedures age? osseous procedures age?
8mo 4-6 >8
Lateral foot xray: angle and beam focus
90, 3-5 met base
Lateral ankle xray: angle and beam focus
90, lateral mall
AP ankle xray: angle and beam focus
90, talar dome
compression therapy is contraindicated with ABI <? also what is the minimum pressure used to treat lymphadema?
<0.8. 40mmHg
ASA Class II (7)
<1 year old >70 year old mild obesity pregnant controlled HTN controllled DM asthma smoking wo COPD anemia
functional hallux limitus is defined by several authors as when comparing CKC and OCK:
<12 degrees hallux DF: CKC >50 degrees hallux DF: OKC
% of body covered by contact dermatitis to Rx an topical vs oral
<20% topical vs >20% oral
normal lab value for cholesterol
<200 mg% W326
medial clear space normal
<4mm
Tib fib clear space vs Tib fib overlap
<6mm clear space (most accurate to determin diastasis) >6mm overlap
when to transfuse due to Hgb (2)
<7 or if drops by 2
1 rad at 12 inches=
=.25 at 24 inches
"DIAL a PIMP" helps with what injury? which is more common? which is a deep cup shaped, less likely to displace?
=location of talar dome lesions - DIAL: Dorsiflexion Internal rotation = Anterior Lateral lesion, -Lateral Lesions: (DIAL, 44% ) Thin "disc", wafer shaped, easily displaced. -PIMP: Plantarflexion Inversion = Medial Posterior lesion (Medial Lesions: (PIMP, 56%) Deep, cup shaped, less likely to displace. "PIMPS are more common, go deep, and like cupped chicks")
when to delay surgery for HTN? must wait until BP is __________ to proceed with Sx
> 200/120 must wait until BP is <180/110
DKA has what aniongap range? what blood chemisty?
>12, metabolic acidosis
threshold of blood sugar that negatively effects wound healing
>250
IDSA treatment for bone/jnt infection with *residual bone infected that is necrotic*
>3mo IV:
Brain Natiuetic Peptide (BNP) levles gold standard to dx?
>500. Heart failure
which organ is damaged if you don't immediately do fasciotomy in compartment syndrome?
??????Kidney, heart, liver or brain?????
causes of AVN "ASEPTIC G"
A - Alcoholism S - Sickle cell disease and Surgery E - Exogenous and Endogenous steroids P - Pancreatitis and Pregnancy T - Trauma I - Idiopathic C - Collagen vascular disease or Caisson's disease G- Gout
irregulary irregular, no discrete P waves sawtooth no identifiable waves
A Fib (" AFi" A fib Irregulary irregular): chaotic and erratic baseline *(irregulary irregular)* with *no discrete P* waves in between irregulary spaced QRS complexes A flutter "A flutter sawtooth): A rapid succession of identical, back to back atrial depolarization waves creating *Sawtooth" appearance* V fib "V Fib is eratic": A completely erratic rythm with *no identifiable waves*
Arthrogryposis
A child born with joint contractures.
Wimberger's ring sign
A circular, opaque radiologic shadow surroundsing epiphyseal centers of ossification in patients with scurvy.
AO pilon fracture classification A-C? 1-3?
A extraarticular B partial articular C articular 1. simple 2. comminuted metaphysis 3. comminuted metaphysis/epipysis
Leomyoma? 3 types
A fibrous, benign tumor of the uterus that usually arises from the myometrium. 3 types: 1. angioleiomyoma: vascular 2. Pilar leiomyoma: arrector pili m. 3. leomyosarcoma: GI and female genital
nerve fiber: size vs mylination A B C
A largest, mylinated B moderate, mylinated C small, unmylinated
PPD test 5mm, 10mm, 15mm of induration means what?
A positive test only tells that a person has been infected with TB bacteria, it does not tell whether the person has latent TB infection or has progressed to TB disease. <15mm=negative test TST reaction of 15mm or more of induration is considered positive in persons with no known risk factors
Trephine
A trephine is a surgical instrument with a cylindrical blade
A. max dose in ml of Bupivacaine 0.25% in a 40kg person? B. toxic ml dose of 0.25% bupivacaine? C. Toxic ml dose of 0.5% bupivacaine?
A. 40kg x 2mg/kg = 80mg / (0.25 x 10)= 80mg/2.5= 32 (must use the 4723 when determining max dose with weight of individual) B. 175mg is max/ (0.25 x 10)= 175/2.5= 70 C. 175mg is max/ (0.5 x 10)= 175/5= 35
nerve fiber function? Which is blocked first? A: -alpha -beta -gamma -delta B C
A: mylinated -alpha: motor -beta: sensory touch and pressure -gamma: propioception. -delta: temperature B-sympathetic tone (also mylinated but smaller than A) C-*dull pain*, temperature, touch, post ganglionic sympathetics (smallest, unmylinated and (1st) to be affected by local)
what are the subtypes of gustilo anderson IIIA,B,C
A: no periosteal stripping B: Periosteal stripping C: vascular comprimise
Benign blood filled cyst, not a true neoplasm, secondary to vascular injury. rapidly grows, painful, Xray: expansive lesion, bubble appearance, soap bubble appearance MRI: hyperintense, lobulated
ABC
ABC vs UBC
ABC Large medullary expansible blowout lucency • Tibia • About to the growth plate • Cortical margins are really messed up • The lesion is wider than the growth plate UBC is non expansitile, may have a fallen fragment sign central, asymptomatic, fallen fragment sign, Calcaneus. "camels are chill as they walk on hees) UBC will not grow wider than growth plate; ABC can expand wider than growth plate and extend into soft tissue
Lateral plantar n prior to division innervates
ABDm QP
Medial plantar n prior to devision innervates
ABH FDB
Gold standard to Dx PAD
ABI
first line of tx for congestive heart failure
ACE inhibitors Loop diuretics
What are reportable diseases same for each state? (6)
AIDS, HIV, syphillis, gonorrhea, chlamydia, chancroid.
Tillaux-Chaput Fracture
AITFL avulsion fx of anterolateral tibia
positive silverskiold
AJ 0 degree with knee straight AJ 10 degrees with knee flexed
Jahss classification: Type 1 and Type 2A,B? aka _____injury? Treatment for each? which one *cant* be closed reduced? which one has the sesamoid lig ruptured? which one is an avulsion off one of the sesamoids?
AKA turftoe injury *Type 1 (CANT CR* due to ST damage) (dorsal dislocation with intact sesmoidal ligament, no fx). -Tx is ORIF reduction Type 2A: Intersesmoid *lig ruptured*, sesmoids are not opposed to eachother Tx: close reduction Type 2B: Intersesmoid lig intact, avulsion fx of one of the sesamoids Tx: close reduction
-disease of mixed UML and LMN resulting in m. weakness -mental stats perserved -males 2x more than females -onset in 40s -death due to respiratory failure 3-5 years after onset
ALS
mixed UNL ad LNL disease
ALS
AP xray normal to rule out liz franc injury
AP: mets and cuns line up
match sounds to its correct murmu: decreshendo high pitch Low pitched and louder on inspiration low pitched and rumbling: high opening snap creshendo decreshendo louder on inspiration holosytolic, constant intensity, blowing increases with inspiration
ARMS PRTS (diastolic) diastolic -Aortic Regurge: decreshendo high pitch -Pulmonic Regurge: Low pitched and louder on inspiration -Mitral Stenosis: low pitched and rumbling: high pitched opening snap -Tricuspid stenosis Systolic -Aortic stenosis: creshendo decreshendo -Pulmonic stenosis: louder on inspiration -Mitral Regurge: Holosystolic, constant intensity, blowing -Tricuspid Regurge: increases on inspiration
ASA class (American Society of Anesthiologists), ASA1: ASA2: ASA3: ASA4: ASA5: ASA6:
ASA 1: normal healthy ASA2: mild systemic disease (controlled DM, prego, or obese, person with asthma ASA3: severe systemic disease or History of MI ASA4: severe systemic disease=constant threat to life ASA5: not expected to live w/o operation ASA6: brain dead, harvest organs
true LLD
ASIS to medial malleolus >0.5cm is significant ONLY VALID MEASURE is X-RAY !!!!!
Liver lab that also assess cardicac (2)
AST (8-20) >=liver and MI. < in pregno, uncontrolled DMII vs >ALT liver (0-35)
Anterior Drawer tests
ATFL >10 mm anterior translation (ATFL only)
how does an partial ATFL tear and dislocated peroneal longus tendon look on MRI. Reason for peroneal tear at cuboid notch and at troclea of calc?
ATFL: (yellow arrowheads) is mildly attenuated and irregular from a remote partial tear. (avascular areas) PL: big red arrow The posterior talofibular ligament (yellow arrow) is intact. A single peroneal tendon (red arrowhead) is seen posterior to the lateral malleolus and the second peroneal tendon (red arrow) is dislocated lateral to the fibula. The peroneus brevis myotendinous junction is visible on the upper image (red arrowhead, 2b). The superior peroneal retinaculum (green arrowheads) is laterally displaced from its normal attachment at the lateral margin of the lateral malleolus, remaining attached to the fibular periosteum (blue arrowheads) which is stripped and elevated by the dislocated tendon. The stripped periosteum forms a false pouch into which the peroneus longus is displaced
"silver dollar sign"
AVN of Navicular "NAVI spend you DOLLAR at KOLEs"
lateral release during bunionectomy carries the risk of
AVN of capital fragment due cutting the nutrient artery in the frist interspace
Insufficient fx
Abnormal bone, normal stress
amount of energy that is absorbed in matter when radiation passes through it
Absorbed dose
Thompson Test vs Homan's sign vs Silverskoid test
Achilles tear "T for Tear and Thompson" DVT (pain with DF) gastrocnemius Equinus
Thompson test
Achilles tendon rupture "Thompson Test Tear"
increased leukocytes=left shift: acute infection vs chonic infection
Acute infection
Heat Therapy contraindications
Acute injuries Imapaired circulation Poor thermal regulation areas of decreased sensaion Neoplasms
Best tx for acute hematoma? (1) vs Late treatment (2)
Acute: Strethcing. Late: Gentle heat and Phyiscal therapy
Deep br of lateral plantar n innervates
AdH DI: 1,2,3 PI: 1,2 Lum: 2,3,4
-Ilfeld's Disease:
Agenesis of the fibular sesamoid
Which graft type doesnt have osteoinduction?
Allogenic graft: own species, non-living cell, has no osteoinduction, not for nonunion!!
which type of graft can be used for a non-union
Allogneic graft
Onychogryposis
Also known as ram's horn or claw nails; an enlargement of the fingernails or toenails accompanied by increased thickening and curvature. "billy goats GRYPh"
why would an amide have higher *risk of toxcity* than an Ester
Am"i"de is broken down in l"i"ver so it is in the body longer with a greater chance of toxcity. Amides are longer lasting than esters, (esters are metabolized by pseuochlinesterase in blood)
SE of thiamine
Anaphylaxis, cyanosis, daiphoresis, restlessness Angioneurotic edema Urticaria Pulmonary edema Weakness, tightness of throat and nausea
Anatomical neck vs surgical neck of metatarsal
Anatomical neck (thinnest, proximal to surgial neck)
Nonhemolytic normocytic anemia
Anemia of Chronic Disease (ACD) Aplastic anemia (pancytopenia)
Fowler & Philip angle
Angle formed from the intersection of a line along the anterior tubercle and the plantar tuberosity and another line along the posterosuperior prominence at the Achilles tendon insertion Normal <70 Haglunds deformity >75°
ABI normal range abnormal ranges. give 3 examples of <0.55?
Ankle brachial index normal 0.9-1.4 >1.4=calcification 0.8-0.9= mild vascular disease 0.5-0.8=moderate vascular disease <0.55=severe vascular disease (gangrene, non healing ulcers, ishcemic rest pain
what is the clubfoot deformity? least and most common race
Ankle equinus hindfoot varus forefoot adduction asian least common polyneasain most common
-site of xray production -site of target -site of focusing cup -site of filament -% of energy is xrrays? Oil for? direction that e- travel?
Anode Anode Cathode Cathode only 1% of energy is conveted to xrays, 99% is heat. the *oil* is for heat exchanger E- travel from - cathode to + anode
plate: used for oblique fractures of the fibula. Its designed to prevent fragments of an oblique fracture from gliding upon eachother during axial pressure. The plate is fixed such that the tip of the distal fracture fragment is wedgned between the plate and the proximal fragment. ie buttress weber B fx with posterior spike. Prevent dorsal-superior displacement
Antiglide plate
Magic Angle Effect
Any MRI signal shot at *55 degrees* to the course of the tendon will show a false positive damage signal, Peroneals are common
murmur that is asymptomatic with elevated BP
Aortic regurg
Rheumatic fever, Marfans, syphilis, endocarditis, congenital. L. heart CHF from overloading. *High pitch diastolic murmur, low pitch rumble mid-diastolic/systolic murmur.* description of heart murmer, earlier diastolic murmer, weird pulses in feet
Aortic regurg "RA get high and rumble"
APGAR is a system to evaluate what categories? what is perfect score?
Appearance (color)-pink Pulse >100 Grimace active motion Appearance-completely pink Respiration-vigorous cry
what does the AO of the prinicples of internal fixation stand for? founder/ year of AO prinples
Arbeitsgemeinscaft Osteosynthesfragen "ow-bites-gimine-shaft" (switzerland) maurice muller 1958
ALARA radiology principle
As Low As Reasonably Achievable
what makes up the Trochanteric anastamosis
Ascending br of MFC Ascending br of LFC
EKG Dx: chaotic and erratic baseline (irregulary irregular) with *no discrete P* waves in between irregulary spaced QRS complexes
Atrial Fibrillation " AFi" A fib Irregulary irregular
EKG Dx: A rapid succession of identical, back to back atrial depolarization waves creating "Sawtooth" appearance
Atrial Flutter "Aflutter sawtooth"
Cardioversion is typically used with which rhythms (2) vs Defibrillation is typically used with which rhythms (2)
Atrial fibrillation or Atrial flutter (AF) vs Ventricular Fibrillation or Ventricular Tachycardia (VF,VT)
The bodys own phagocytic debridement, which is encouraged by a moist occlusive dressing such as hydrogel is what kind of debridement
Autolytic debridement
What function is lost first with spinal anesthesia?
Autonomic activity
Lack of Intrisic factor (IF) causes what type of anemia
B12 def (macrocytic anemia)
Lymphedema Pump Contraindications (11)
BIG DEC P Blood: PVD, Arterisclerosis, Ischemic vascular dz Infection Gangrene DVT Dermatitis Displaced fractures Edema 2ary to CHF Compartment Syndrome Pulmonary edema
large static magnetic field aka
BO: The B0 in MRI refers to the main static magnetic field and is measured in teslas. The majority of MRI systems in clinical use are 1.5 T, with increasing numbers of 3 T systems being installed. Altering the field strength will affect the Larmor frequency at which the protons precess.
Difference between bacteremia and septicemia
Bacteremia: Bacteria presence in blood, does not equal to infection. Septicemia: Actual colonization, localized infection 10^6
epidermal inclusion cyst
Benign cyst usually found on the skin developing from ectodermal tissue; Histologically, it is composed of a thin layer of squamous epithelium
inflammatory changes in small-medium arteries and viens caused by hypersensitivitey to tobacco. what is most important for healing?
Beurger Disease (Thromboangiits Obliterans). smoking cessation
Foster's fx:
Bil talar tubercle fx
Bimalleolar fx aka Trimalleolar fx aka
Bimalleolar: Pott's, M/L malleoli Trimalleolar: Cotton's, M/L and posterior malleoli (pic)
Cauda Equina Syndrome
Bladder/bowel dysfunction, sexual dysfunction saddle anesthesia, back pain with radiation to leg, absent Achilles reflex,
Which has highest intensity on ultrasound?
Bone (highest) (high impedance) Muscle Blood Water Fat Air
Cancer staging system (2)
Breslow: depth in mm and % 10 year survival rate. "hold your breath before diving deep" Clark: layers of skin. clark explores layers"
plate: modified neutrilizaton plates used to maintain lenght during healing without disrupting the damaged portion of bone. they act to bridge the bypass area of comminution. Screw are placed only in the major proximal and distal segments to avoid the fracture site
Bridge plate
what are the primary lesions (12)
Bulla, burrow, cyst, macule, nodule, papule, patch, plaque, pustle, tumor vesicle, wheal
Butress vs V shape thread has a geather resistnace to bending forces
Butress
types of periosteal response (5)
Buttressing (thick periostitis) Codman triangle Sunburst Onion Skin Hair on End
origin and insertion of poplieteus m
CKC O/I: tibial shaft above soleal line---popliteal groove on lateral epiconyle of femur
CMT I vs CMT II
CMT I: hypertrophic demilination CMT:II no hypertrophic demilination
clubbing nail systemic pathology (3)
COPD, cirrosis, congenital heart defects
Diminished bone density disease (5)
CRPS Rickets/Osteomalacia Scruvy Hyperparathyroidism Hyper/hypo thyroidsim "CRuSHH the bone"
Which imaging is the mainstay of diagnostic accuracy in regards to Lisfranc injury?
CT
gold standard to dx PE
CT pulmonary angiography
Gold standard to evaluate a calc fracture
CT scan
Jhamaria
Calcaneal index
CREST syndrome
Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia
pt with CHF, what medication shouldnt ve used
Calcium channel blocker
antibioic beads are commly mixed with what as its transport mech
Calcium sulfate
bloody stool micro (6)
Campylobacter E. coli E. Histoylytica Salmonella Shigella Yersinia enterocolitica
which type of scew has a larger pitch?
Cancellus scews (providing a larger surface area for scew to grab on to cancellous bone) (cancellus screws also have a lager thread to core ratio
Post MI markers: Cardiac tropoin 1 time frame -besides the heart what other organ is it found in? vs CK-MB time fame -what part of the heart is it found in?
Cardiac troponin 1: most specific protein marker "Im #1" (also seen in renal failure but studies have found that the increase resulted from the MI first.) increased 4 hr post MI for 2 weeks CK-MB: found in myocardium rises 6-12 hr post MI and returns to normal 2 days
normal anion gap? causes?
Caused be Metabolic Acidosis normal 8-12 Hyperventilation Addison disease Rrenal tubular disease Diarrhea Acetazolamide Spironolactone Saline infusion
what type of foot deformity is described bewlow: Increase cal inclination, decrease talar declination, decrease lateral/DP talocalcaneal angle, accentuation of sinus tarsi, increase MAA. claw toe, NV disorder(SMT), FF ADD, RF varus.
Cavus foot "CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.
why would a Cyclooxygenase 2 inhibitors be preffered in perioperative setting
Celecoxib (Celebrex) becuase is maintains platelet function w/o the GI side effects CI in sulfur allergy
Causes of nystagmus 3/12
Cerebellar nystagmus Congenital Spasmus nutans Acquired Pendular nystagmus: Jerk nystagmus: Other causes Lack of development of normal eye movement Albinism, nearsightedness(myopia) or astigmatism Congenital cataracts Inflammation of the inner ear Anti-epileptic medications or CNS disease
Ataxic gait is from which part of brain?
Cerebellum
Bridle Procedure treats what condition? what tendons are transfered (3)
Cerebral Palsy transferes TibP, TibA, PerL 443
Speech defects -retardation -ankle equinus -seizures -visual defects -upper motor neuron disease "scissors gait"; hyperreflexia, hypertonicity and spastic paralysis; presents with adducted knees and walking on toes Disease. most common tx for pes valgus deformity
Cerebral palsy. Evans lateral column lenghening
Sanders and Frykberg classification
Charco classification location: I. digits II. Lis Franc III. MTJ IV: ankle/STJ V: Calc
Classification based on the apex of the cavus deformity: Choparts joint? lesser tarsus bones? lisfranc joint?
Choparts joint= forefoot cavus lesser tarsus bones= lesser tarsal cavus lisfranc joint= metatarsal cavus
incision classicaly used for ST release in clubfoot
Cincinnati incision
A patient with a history of true penicillin allergy is scheduled for a total joint implant. Antibiotic prophylaxics would be (2)
Clindamycin Vancomycin
Dorsiflexory wedge osteotomy through naviculocuneiform joint and cuboid bone
Cole
schedule III drugs (5)
Combination products with less than 15 milligrams of hydrocodone per dosage unit *(Vicodin)* Products containing less than 90 milligrams of codeine per dosage unit *(Tylenol with codeine)* *Ketamine* *Anabolic steroids* *Testosterone*
myelomeningocele
Common and serious type of spinal bifida, spinal cord protrude out of defect. Lower motor lesion, flaccid paralysis,
2 locations for general bone stimulator uses:
Compression side: electro (-) current, osteoblast Tension side: electro (+) current, osteoclast (T,+, adding blood ca(osteoclast))
Pediatric deformity: Persion Slipper, reverse clubfoot, congential pes planovalgus aka Treatment:
Congenital Vertical talus Tx: closed reduction with casting rarley works. Open reduction is most succesful. goal is to do a posterior release and reduce the TN joint. If kid is >6 old, wait unilt osseus maturity and then do a triple arthrodesis
Apert's syn
Congenital massive multi-coalitions
Jurisprudence
Constitutional Law
most common in podiatry for OM of the Waldvogel classification
Contiguous
I dentify MRI muscle belly: Coronal T2 of abductor hallucis, abductor hallucis, quadratus plantae, abductor digit minimi
Coronal reformatted T2-WI showing clearly the hyperintense medial plantar veins (arrow) in normal conditions. The veins are surrounded by the m. abductor hallucis (1) medially; the m. quadratus plantae (2) deeply from the veins; and the m. flexor digitorum brevis (3) laterally. The muscle belly of the m. abductor digiti minimi (4) is located at the lateral plantar aspect of the foot.
40 YO M cough and fever: HIV + and is getting headaches - Disease? Tx
Crypto Meningitis - he has HIV Fluconazole: 400mg IV first day then 200-400mg qd
Cushing Dz vs Cushing syndrom how to diagnose cushing syndrome
Cushing dz: increased ACTH (tumors) Cushing syndrome: decreased ACTH (buffalo) Dx: Dexamethasone supression test will result in high dose=decreased ACTH, low dose =decreased ACTH
CAGE questionare
Cut down. Annoyed. Guilty. Eye-Opener. Each yes = 1 point. 1 point = ETOH abuse suspicion. >1 point = Strong Indication.
gold standard to diagnose osteoporosis
DEXA scan
Dorsiflexory wedge osteotomy of the 1st me or all mets
DFWO
disseminated intravascular coagulopathy. (DIC) def? "STOP Making New Thrombi"? PT, PTT, BT, PC?
DIC: widespread clotting--> deficiency in clotting factors--> bleeding state"STOP Making New Thrombi" Sepsis Gram-negative sepsis provokes DIC Obstetric complications actute Pancreatitis Malignancy Nephrotic syndome Transfusion -Increased PT, PTT, BT -decreased PC
where are of ivory phalanx, pencil in cup located?
DIPJ
DKA treatment order vs Hyperkalemia treatment order
DKA: INK I vs Hyperkalemia: C BIG K
Indications for wound vac, (7)
DM wounds Venous leg wounds Traumatic wounds Skin grafts pressure ulcer partial thickness burns flaps
Projection angle: DP projection of foot? DP projection of foot with marked lesion? Lateral foot? Lateral Raised digit/Hallux? Lateral oblique? Axial Sesamoid?
DP projection of foot? 15 DP projection of foot with marked lesion? 0 Lateral foot? 90 Lateral Raised digit/hallux? 90 Lateral oblique? 40 Axial Sesamoid? 90
Danis Weber fib fx Mech of injury location in lauge hansen Type A Type B Type C
Danis Weber fib fx Mech of injury location: Type A SAD 1 Transverse avulsion fx of lateral malleolus at or below ankle. Type B SER2, PAB3 Spiral fx of lateral malleolus at the level of tibial plafond (most common) Type C PER3 High fib fx, tibio-fibular syndesmosis rupture. (maisonneuve fracture)
RX treatment for Malignant Hyperthermia
Dantrolene 1. IV 2.5mg/kg rapidly 2. Oral 1-3 days after episode W502
What is the dose and drug you use in treatment for Malignant hyperthermia and how do you treat the arrhythmia caused by this pathology? moa for this drug
Dantrolene 2.5mg/kg IV; use Procanimide for the Arrythmia decreasing free intracellular calcium concentration
location for Incision DeVries vs Olliers vs Cincinnati
DeVries: medial vs Olliers: lateral vs Cincinnati: posterior
surgical dos/donts for OM in the OR (5 Ds)
Decompress: no tourniquet Drainage: lavage with plain NaCl Debridement: Excise necrotic, 2cm clear margin Dressing: Pack, open, place drain 2-3 days, daily dressing change Drug x 6 week PICC line IV, delay closure until culture
biguanides moa? DOC?
Decrease production of glucose in liver -Metformin (glucophage) SP72
Wellen's sign
Deep inverted T waves
anterior tarsal tunnel, anterior muscle compartment involves what nerve
Deep peroneal
Is Thrombotic thrombocytopenic purpura (TTP) a bleeding disorder or a hypercoagulable disorder Where does it affect? BT, PC
Deficiency in ADAM 13 -increase Bleeding time -decrease PC "FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities.
stock and glove style weakness, loss DTR, min muscle atrophy, sensory loss, ataxia, short stature, and scoliosis.Demyelination, nerve hypertrophy, slow nerve conduction.
Dejerene-Sottas (CMTIII)
-Delayed union def, time frame, tx vs -Non union: time frame (2), tx vs -Pseudoarthrosis: def, tx vs -Malunion
Delayed union: *beyond* average heal time. 3-6 month. strict immobilization vs non union: *>9 month old fx OR no change in 3 mo*. Bone stim, Revision, Bone graft vs Pseudoarthrosis: *fibrocartiaginous* develops at End stage non-union. Rrevision vs malunion: fx heals *anatomically incorrect* position
Most of blood supply to talus
Deltoid artery branch from Posterior tibial artery
Gottron sign
Dermatomyositis antinuclear antibodies in 80% pts
symptoms of hypoglyceia (6)
Diaphoresis(sweating)/syncope Tachycardia/palpatations Hunger Anxiety/irritability Tremors/seizures/mental confusion weakness
Defuse enthesophyte formation (ligmentous calcification).
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
rosenthal
Digital fracture classification/ tx: zone 1: completely distal aspect of phalanx: secondary healing zone 2: completly distal to lunula: flaps zone 3: distal to IPJ in hallux or DIPJ in lesser: distal symes amputation
Draw the nemonic for tetnus booster
Dirty >3 Td shots===none >5yr since last shot ===give Td Dirty <3 Td shots==Give BOTH Clean <3 Td shots ====give Td Clean >3 Td shots===none > 10yrs since last shot===Give Td
Structure for spinal block injection vs epidural block location
Dissection through the *dura matter* and the arachnoid matter and place it in the *subarachnoid space*. vs epideral space
why choose Distal over proximal akin
Distal akin: corrects IPJ Proximal akin corrects DASA
how to produce shortening and Plantarflexion with an Austins bunionectomy
Distal medial dorsal Proximal lateral plantar
most important of the cardinal principles of radiation protection is
Distance (inverse sqare law)
Parallel Pitch lines? If ______tubercle extends above superior parallel line=????
Draw a ling along plantar surface of calc, then draw a perpendicular that passes through the posterior aspect of the posterior facet At the point where the 2nd line passes through the posterior facet, draw another perpendicular line, parallel to the CIA If *posterior tubercle* extends above 2nd parallel line= *Hagland's deformity*
Dorsiflexory fusion through the MTJ
DuVries
disease: -progressive neuromuscular weakness -atrophy and muslce wasting affecting hips, pelvic area, thighs, shoulders, calves -loss of DTR -waddeling gait -secondary contactures -Proximal muslce weakness including neck m -Pseudohypertrophy of calves (fat depositis)
Duchenne's muscular dystrophy
lateral closing wedge or an opening medial wedge
Dwyer
surgical correction for a coleman block test with results in the hindfoot remaining in varus? how does the surgical correction correct the varus?
Dwyer: Lateral closing wedge (or an open medial wedge)
base of proximal phalanx is landmark for? 2
EDB inserts onto EDL. FDB splits so that FDL can pass through.
Hibbs Tenosuspension uses what muscels indication
EDL (cavus), hammertoes
Lateral terminal branch of deep peroneal nerve innervates (2)
EHB EDB
Medial oblique projection ankle xray: angle and beam focus
ER 45, beam on the vertical between the medial mall
3 lab markers for infection
ESR (0-30) >60 OM CRP (0-10) >3.2 infection procalcitonin(<2) >2-10
normal ranges ESR: CRP: Albumin: Pre-Albumin: ALT: AST:
ESR: 0-30 >infection CRP: 0-10 (0-0.1) <infection Albumin: 3.5-5 <malnutrion Pre-Albumin: 15-30 <malnutrition ALT: 0-30 >liver AST: 8-20 >(liver and MI)
difference between Eccine sweat gland and Apocrine sweat gland
Eccrine sweat glands open onto skin and are found all over body Apocrine sweat glands: open into hair follicules, found in armpit and crotch
Dermal infection, deeper more serious form erythromycin.of impetigo. May ulcerate.
Ecthyma
Diabetic abcess characterisitics (5)
Edematous Febrile Malodorous Purulent drainage cellulitis (clinical signs of)
Charco classifications (4)
Eichenholtz Brodsky Schon Sanders and Frykberg
null hypothesis
Either reject or fail to reject. Cannot prove null hypothesis, just means thereis or is not enough evidence to prove significance of the tested hypothesis.
common CI for joint implants (4)
Elderly non-ambulatory, young athlete (quicker failure), osteopenia, active infection
disease constantly present in a speficicaly smaller grouped population -common cold -chicken pox -malaria vs is a global or multiple county outbreak. -HIV/AIDS, -spanish flu, aisian flu ect , -SARS, vs rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. -meningococcal infections -black plague -yellow fever -polio
Endemic, Pandemic, Epidemic
Rule of 9's adult Entire Head = Chest (front) = Abdomen (front) = Upper back= Low back and buttocks = Each Entire arm = Groin = Each entire leg = hand vs foot=
Entire Head = 9% Chest (front) = 9% Abdomen (front) = 9% Upper back= 9% Low back and buttocks = 9% Each Entire arm = 9% (front = 4.5%, back = 4.5%) Groin = 1% Each entire leg = 18% total (front = 9%, back = 9%) hand=1.25% foot=3.5%
bone tumor locations acronym- Epiphysis (4) Metaphysis (8) Diaphysis (4)
Epiphysis: GCT, CB, CCC, IG "Interesting, Giant, is Clearly Blast" Met: O,O,O, CMF, NOF, CS, F, E "NO EFCS" Dia: ES, M, M, CS, "EF=M^2Cs"
Hibbs Tenosuspension Indication
Equinus without or without claw toesx`
infection of the skin, well demarcated that are swollen and indurated. caused by actute SUPERFICIAL form of celluitis involving the lymphatics. Its acute and symtoms consist of fever chills
Erysipelas vs Cellulitis deeper penetration into dermis and subq
Basal Cell carcinoma: cause/location? aka? vs Squamous cell carcinoma: cause/location?
Excessive sunlight or radiation "Beating sun/radiation" (upper face, sun exposed areas) aka rodent ulcer vs carcinogens (smoking, sunlight, ingestion of arsinic, radiation) "Squashed by carcionogens" (lower face, sun exposed areas)
Advantages of meshing in graft application (4)
Expands tissue size Allows drainage of hematoma/seroma Allows for irregular surfaces Increase SA for re-epitheliazation
what is the term that describes the *amount of ionization* that is produced when radiation passes through it?
Exposure
Hammertoe etiology:
Extensor Substitution
insertion for lumbricals
Extensor wing of respective digit
Ankle joint axis #s? axis direction?
F: 20-30 T: 8 S: 82 axis: Lateral plantar posterior to medial anterial dorsal
STJ axis
F: 48 T: 42 S: 16
Midtarsal joint longitudinal axis vs Oblique axis
F: 75 T: 15 S: 9 vs F: 38 T: 52 S: 57
Infracalcaneal spuring is caused by
FDB (not plantar fascia)
Vertice ridge of tibia seperates what 2 muscles
FDL (medial) (dick) TP (lateral) (tom)
Plantar proper digial br of the superficial division of the lateral plantar n innervates
FDMb DI: 4 PI: 3
Intrinsic posting does what to FF
FF balanced on RF vs extrinisch posting: FF non balaned on RF
Emergent reversal of Warfarin vs non-emergent but quick reversal of warfarin? vs non-emergent, slowest reversal of warfarin?
FFP vs IV vit K vs oral vit K (most common form of vitamin K) it also doenst have the SE that IV vit K has
Plantar proper digial br of medial plantar n innervates
FHB
sesamoids act as apulley for what m
FHB
FDL vs FHL which is stronger when compared for a tendon transfer for posterior tibial tendon
FHL
T:F OSHA requires medical and dental offices to maintain an official log of reportable injuries and illnesses
False
how to Dx DM: fasting blood sugar? oral glucose toloerance test? A1c?
Fasting plasma glucose >126 Oral glucose tolerance test >200 A1c >6.5
secondary centers of ossificatin from Femur (4), patella, tibia (2)
Femoral head: 1 year age Greater trochater: 4 yr age Less trocanter: 13 yr age Distal femur: 9 mo FD Patella: 4 yr age Proximal tibia: 9m Distal tibia: 1-1.5 yr age
most common ST sarcoma of adult
Fibrous histiocytoma
Indication for arthroereisis (2)
Flexible pes planus PTTD
tarsal tunnel borders
Flexor retinaculum Calcaneus and posterior talus distal tibia and medial mal
Reye Syndrome (RS)
Flu complication, when children are given Asprin: a disorder defined as a metabolic encephalopathy associated with other characteristic organ involvement. It is characterized by fever, profoundly impaired consciousness, and disordered hepatic function
Reversal agent for benzos for benzo overdose anything ending in "-am", others include Chlordiazepoxide or Clorazepate
Flumazenil
what is the xrya machine that aloows real time moving images
Fluroscopy
what are the macrocytic anemias
Folate acid def Vitamin B12 def (neuro symtoms) megalblastic anemia Orotic aciduria phenytoin, cytotoxic meds W322
total angle of ruch
Fowler & Philip angle + calcaneal inclination angle Normal 90° Haglunds deformity >90°
3 angles to assess hanglunds deformity? radiographic pathology angle for each?
Fowler-Philip angle? >75 Total angle of ruch: >90 Parallel pitch lines: post tubercle popping up
Partial matrixectmy options? (4)
Frost modified frost plastic lip Winogad
types of frostbite (5)
Frostnip (mildest): short exposure Chillblains (pernio): repeat exposure with humidity Trench foot: prolong exposure high altitude mechanism
which bone scan is CI in kids
Gallium 67
posterior leg muscles from superficial to deep
Gastroc Plantaris Soleus
Best treatment to lengthen heel cord with a positive silverskoid test
Gastroc recession because weve isolated that the equinus is due to the gastroc. After gastroc recssion is performed the equinus is fixed positive test= can AJ 0 degree with knee straight AJ 10 degrees with knee flexed)
most common lysosomal storage disease
Gaucher dz (hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises, gaucher cells)
Recently went hiking and now has GI disturbance - most likely cause? Tx
Giardia - drank river water treat with Metronidazole
most common primary intracranial tumor
Glioblastoma "GLI im #1"
"MARTEL the RAT is SWELLING from EROSIONS and PUNCHED out the wall but SPARED the JOINT SPACE
Gout: Martels sign rat bite increased swelling erosions, punched out lesions Joint sparing
pretibial myxema is associated with
Graves (hyperthroidism)
Both pretibial myexedam and Exopthalmus are found only in
Graves disease
Ecthyma (Dermal infection, deeper more serious form erythromycin. of impetigo. May ulcerate.)micro
Group A strep
two micro bugs that can cause fever within a few hours of surgery
Group A strep (GAS) Clostridium perfringens
hexacarbon abuse can mimic what micro bug
Guillian barre (casues ascending paralysis)
diagnose: -long 2nd metatarsal -oval or rounded first met head -women -hypermobility
HAV
Roots classification (4 stages)
HAV: 1. sagittal groove formation 2. HAA and PASA inreased, ADL bowstring 3. IM increase 4. End stage, subluxed hallux
Hepatitis B, needle stick, what to look for in serum
HBsAg
*Proximal white onychomycosis* with rapid extension from the proximal to the distal nail is unusual but can be suggestive of?
HIV or other conditions of immunocompromise
which health care has a "gatekeeper"
HMO An HMO is a closed health care system where all access to care is controlled by the primary care provider (gatekeeper).
difference between HMO and PPO
HMO: -may require you to select a (PCP), who will determine what treatment you need. -may need a PCP referral (a gatekeeper) to be covered when you see a specialist or have a special test done. -If you opt to see a doctor outside of an HMO network, there is no coverage (out of pocket), -*Premiums are generally lower* for HMO plans, and there is *usually no deductible or a low one.* PPO: -You can see the doctor or specialist you'd like without having to see a PCP first. -You can see a doctor or go to a hospital outside the network and you may be covered. However, your benefits will be better if you stay in the PPO network. -*Premiums tend to be higher*, and it's common for there to be a *deductible.*
HMO cost, coverage and restrictions
HMOs tend to be: -more affordable -less coverage -more restrictions.
when should a chemistry profile be ordered preop (7)
HO hypertension, diuretic use COPD obstructive slee apnea DM renal disease chemotherapy
Removal of both sesamoids what can occur
Hallux Malleus can form
What are standard precautions?
Hand washing and PPE(personal protective equipment)
Hapalonychia: Herpetic whitlow: Hippocratic nails: Intraungal hematoma:
Hapalonychia: hyperhidrosis causes rubbery nails Herpetic whitlow: herpetic infection at distal phananx Hippocratic nails: clubbing nails Intraungal hematoma: hematom within body of nail
Hard vs Soft xrays: -kVp -wavelenght -frequency -penetration -energy
Hard: -produced by increased kVp, -short wavelenght, -high frequency, -increased penetration, -less dangerous to pt, -higher energy above 5-10kVp vs soft: produced by decreased kVp, long wavelenght, low frequency, low penetration, lower energy, more dangerous to pt
best xray to view STJ coalitions most common cause of tarsal coalition
Harris-Beath failure of segmentation of primitive mesenchym.
-Talar neck fracture classification name: -% AVN for each type? -Hawkins sign
Hawkins: Type I: *talar neck* without displacement (AVN risk 10%) Type II: add *STJ* (AVN risk 42%) Type III: add *ankle*, (AVN risk 91%) Type IV: add *TNJ* (AVN risk 100%) Hawkins sign: Represents sign of viability. Its subchondral atrophy due to hyperemia, usually seen 6-8 weeks after injury
Heat stroke vs. Heat exhaustion
Heat stroke Fever above 104F, irrational behavior, extreme confusion, dry, hot and red skin, rapid and shallow breathing, rapid and weak pulse, seizures and unconsciousness. can progress to damage to organs and brain, extreme cases can cause death Heat exhaustion Headache, dizziness and light-headedness, weakness, vomiting and nausea, cool and moist skin, dark urine. If do not feel better within 30 minutes, can progress to heat stroke. Kim had this in moab. she was exhausted.
Wells score
Helps estimate the risk of a patient having a deep vein thrombosis
stages of healing/ time frame (4). which stage does contracture occur (healing occuring as wound gets smaller towards the center)
Hemostatis: 2min- 2hours Inflammatory (substrate): 2 days *Proliferaative.* (fibroblastic): 2-3 weeks Remodeling (maturation): >>2-3 weeks
fibula bone autograft is harvested via which tecnique
Henry approach
DNA virus associated with Membranous and membranoproliferative glomerulonephritis, arthralgia, poly arteritis nodosa
Hepatitis B
What is Ramsay Hunt syndrome?
Herpes infection in ear and facial paralysis
pes cavus tendon transfers (4)
Hibbs Jones STATT PT transfer "CC PIST F b/c she is cavus" CMT, Cerebral palsy, polio, Infection (syphilis) spinal bifida, Trauma Friedrich's ataxia etc.
Highs TENS vs Low TENS
High 100-500 Hz blocks pain receptors, can use up to 24 hours per day, cause when off the pain comes back Low 1-50 Hz produces endorphins 15-30min
how to calculate ABI? left PT: 110 left DP:100 left arm: 130
Highest DP or PT Systolic /Highest RUE Systolic 110/130= 0.84 (L ABI)
Reed-Sternberg cells
Hodgkin's lymphoma
what is the procedure to treat RA, HT by resection of the 1st MTPJ and excision of the lesser MT heads
Hoffman-Clayton
what law describes strain (deformity) of material is proportional to stress applied
Hooke's law: strain (deformity) of material is proportional to stress applied
Hyper vs hypoglycemia: onset? neuron damage?
Hyper- slow onset Hypo- rapid onset Hypo-neuron damage
Loop Diuretic SE (5)
Hypokalemia, hyperuricemia, glucose intolerance, hypercholesterolemia, sexual dysfunction.
De Quervain: general
Hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens
Mallampati Score
I - soft palate, fauces, uvula, tonsillar pillars II - soft palate, fauces and uvula III - soft palate and base of uvula IV - soft palate not visible
Rowe classification. I A-C (which would be confused with a calcaneal secondarius) II A-B III A-B IV V
IA: medial calc tuber, IB: sustentac IC: Ant proc (confused with calc secondarius) IIA: "Beak fx", no achilles, IIB: "tongue fx" avulsion of achilles IIIA: Simple ext-artic, IIIB: Comm ext-artic IV: Comm intr-artic body fx with/o depression V: Comm intr-artic body fx with depression W476
what schedule durg is Percocet
II (high abuse potential, Rx required)
calculate True IM angle
IM + (MA-15)
splay foot
IM angle >12 with 4th and 5th met ankle >8
Lateral oblique ankle xray: angle and beam focus
IR 45, lateral mall.
heloma molle location 3rd interspace (2)
IS3: head of 3rd proximal base of 4th middle (or head of 4th prox and base of 3rd middle)
Ober test
IT band tightness
ASA class? Cardiovascular disease Renal disease with renal impairment unstable angina symptomatic COPD
IV Mcglamery 56
Protected health information definition
Identifiable, demographics medical history, mental health, diagnostic, lab test, blood work treatment info Payment info
Harvesting sites for bone autograft (7)
Iliac crest Rib Greater trochanter Fibula Proximal tibia Distal tiba Calc
where is physis on bone located
Inbetween epiphysis and metaphysis
How do you prevent atelectasias in a pt with Pulmonary Disease? (3)
Incentive Spirometry CPAP Stop smoking
Limb lenght Discrepancy. what is seen on the short side (3) If its not listed in these 3, its safe to say the remainder of the compensations are on the long side.
Increased STJ supination Increase pelvis height Increased shoulder height
hyperparathyroidism: (4)
Increased osteoclast hypercalcemia bone resorption hypophosphatemia
thiazolidinediones moa? 2 drugs?
Incrrease peripheral cellular response to insulin -Rosiglitazone -Pioglitazone P72
DOC for acute gout /other options (2) DOC for chronic gout / other options (2)
Indomethacin (other options: cholchicine, predisone) Allopurinol (other options: Febuxostat, Pegloticase)
most common causes of immediate post op pain when narcotics dont releive pain? (3) post op pain after 48 hours is due to (6)
Infection, Hematoma, Dressing pressure >48 hours -sutures too tight -dressing too tight -hematoma -edema (foot in dependant position) -Vasospasm from K wire -Compartment syndrome
PEDIS system
Infectious disease socicity of america to evaluated serousness of an ulcer. each topic gets scored 0-2, Perfusion Extent Depth Infection Sensation
cortical bone infection only
Infectious osteitis
Inflammation at or near the insertion site with swollen, taut skin with pain. Blanching and coolness of skin around IV site. No backflow of blood into IV tubing on lowering the solution container
Infiltration (needle goes right through the vien)
Thromboangiitis obliterans (Buerger disease)
Inflammation of the medium-sized arteries and veins because of thrombotic occlusion, resulting in ischemia and gangrene.
First branch of saphenous nerve
Infraptellar branch
Anodyn therapy use
Infrared to increase circulation, reduce pain, stiffness, muscle spasms
Anodyn therapy moa
Infrared to increase circulation, reduce pain, stiffness, muscle spasms causes local release of nitric oxide which stimulates vasodilation to increase circulation
by day 3 of graft healing what is happening
Inosculation phase: capillary buds make contact with graft
Inspiration vs expiration chest movment/diaphragm?
Inspiration: diaphragm contracts, chest expands Expiration: diaphragm relaxes, chest contracts
CMT affects muscels in what order?
Instiniscs (smallest muscles), PB, PL, TP, Surae (largest)
lemont's nerve
Intermediate dorsal cutaneous
what are the stages of PVD
Intermittant claudication Rest pain Gangrene
ABI intermittant claudication score vs rest pain
Intermittant claudication: 0.5-0.89 rest pain: 0.2-0.49
Interosseus lipoma on xray and MRI Xray: if in calc, its in anterior process. Osteolytic lesion with central calcified nidus. commonly within neutral triangle of calcaneous MRI: MRI also shows the signal intesnity of fat
Interosseus lipoma
lumbrical, interossi, neuroma in relation to DTML
Interosssi-dorsal *DTML* lumbrical, neuroma-plantar
what is Engles angle? normal? greater or lesser=metatarsus adductus.
Intersection between 2nd met with medial cun. normal is 18-24. increased is MA
stewart 2 fracture
Intra-articular base of 5th met base
difference between STJ arthroreisis implants Intraosseus vs Extraosseus ar
Intra=requuire bone resection (not used much anymore) extra: no bone resection, instead its simply screwed into place Type 1-sinus tarsi Type 2-narrower which allows them to penetrate sinus tarsi and deeper canalis portion of sinus tarsi
Osteolytic lesion surrounded by a thin, well defined sclerotic border. Internal osseous ridges are frequently present and bone expansion seen, in neutral triangle of calcaneous
Intraosseus lipoma
is Von Willebrand disease a bleeding disorder or a hypercoagulable disorder?
Intrinsic pathway coagulation defect -increase to normal PTT. Increased bleeding disorder
Inverted Blake posting
Intrinsic varus posting
6 month old, what is the most common cause of anemia?
Iron deficiency anemia due to GI absorption issues
what view is used to see the STJ factets on xray
Isherwood W202
Difference between Isherwood and Harris and beath
Isherwood: anterior facet of STJ Harris and Beath: Middle and Posterior colalition
what anesthetic agent has the lowest MAC? and a low MAC= how potent?
Isofurane "ISO potent" (making it the most potent): Inhalated anestheic that decreases BP by vasodilation only. No cardiodepressant actiity. (Isufurane, desflurane and succinylcholine are only 3 drugs that can cause malignant hyperthermia) W56
anesthetic with the lowest MAC
Isofurane (most potenent) and pungent
muscle contraction with associated joint motion and change in muscles lenght. Can be preformed in a cast (free weight exercise
Isotonic
Explain how the STJ is a torque converter
It converts transverse leg motion to triplanar motion of the foot. (tibia rotates on femur creating a shearing force, STJ translates this force to transverse plane motion of the foot)
Dorsiflexory wedge osteotomy across the tarsometatarsal joints
JAHSS procdure for cavus deformity
MRI classification for PTTD
Jahass or Janis classification
V-osteotomy of midfoot with the apex of the V most proximal located in navicular and the lateral distal cut extend to cuboid and medial limb
Japas
Junctional Nevi vs Dermal Nevi (Intradermal Nevi) vs compound Nevi
Junctional: flat and hyperpigmented Dermal: raised and flesh colored, sometimes pigmented, rarley malignant compound: raised and hyperpigmented combo between junctional and dermal type
voir dire
Jury selection process of questioning prospective jurors, to ascertain their qualifications and determine any basis for challenge.
arthritis association Iridocycolitis vs conjunctivitis
Juvenile rheumatoid arthritis vs Reiter syndrome
difference between K wire and Steinmann pin
K wire are smaller in diameter (inches) and Steinmann pins
total matrixectomy options (5)
Kaplin Suppan #2 Syme (lapidus) Whitney Zadik
Chilectomy with proximal hallux phalanx resected
Keller
Arthroplasti options for 1st ray surgery of hallux rigidus(4)
Keller Mayo-heuter Stone Valenti W399
tissues lease sensitive to radiation (3) vs tissue most sensitive to radiation (4)
Kidney, muscle, nerves vs bone marrow with lymphocytes, reproductive cells, GI
Pedal hyperhidrosis is generally found to be caused by
Kytococcus sedentarius.
most common sciatic disc location
L4-5
L4 vs L2 vs L1 radiculopathy symtoms
L4or L3: anterior thigh/leg L2: antero-medial in the thigh L1: groin
meromelia
Lack part of a limb
what more closely mimics human plasma with a pH of 6.5, more so than normal saline? contents:(5)
Lactated Ringers contents: Na,Cl,K, Ca, lactate
Guillan-Barre aka
Landry's Paralysis
what causes a faster, darker image film? (2)
Large size of the AgBr crystals thicker the emulsion layer
which Isherwood position is used to see the posterior facet of the STJ?
Lateral Oblique Axial Position W202
What view can you not see os peroneum
Lateral oblique will not see os peroneum
attachement for Posterior Talofibular ligament
Lateral tubercle---Lower portion of malleolar fossa
if someone had reaction to lidocaine what is it most likely it is? (2)
Latex, PABA,
Amputation: the calcaneus is sawed through horizontally instead of vertically so that the pt steps on the same pard of the heel as before
Lefort (boyd) amputation ( modification of pirigoff)
MRI T1 vs T2 hemangioma
Left: T1 Right T2
MRI T1 vs T2 fracture line
Left: T1 Right: T2
stare decisis
Let the decision stand (the rule that a court tends to follow its previous decision based on similar facts)
What are the amide local anesthetics?
Lidocaine, Mepivacaine, bupivacaine, Ropivacaine (less cardio toxicity than bupivacine, $$$) (amide's have 2 I's in them)
False Claims Act aka
Lincoln Law
Lindsay nail: describe and cause Mees lines: describe and cause Muehrcke nails: describea nd cause
Lindsay nail: distal half is pink, proximal is white (pic) due to liver disease and azotemia Mees lines: single traverse white band-arsenic Muehrcke nails: horizontal white band, hypoalbumemia
most common ST tumor of all ages
Lipoma
Chondomyxoid fibroma, giant cell tumor and ABC have what in common
Lobulated, Expansitile (pic is chondromyxoid fibroma. notice the scalloped borders
Initial treatment for acute DVT treatment
Lovenox =enoxaparin (1mg/kg SC q 12)
Highest CA mortality
Lung CA
Physcial therapy with manal lymphatic drainage, massage and exercise is first line tx for
Lymphadema
Brown tumor of hyperparathyroidism
Lytic bone lesion that develops with persistent hyperparathyroidism that gets its color from abundant hemorrhage and hemosiderin within the lesion
difference between MA, skew foot, Club foot
MA is metatarsals only skew foot involves rearfoot pronation clubfoot involves rearfoot supination
C-N coalition will see comma sign on what view?
MO view
Lachman's Test
MPJ ligament stability (>2mm displacement=(+) test)
what/why is the most specific and most sensitive imaging modality of diagnosing OM
MRI-can detect OM as early as 3-5 days pic is T2: bone marrow edema central high signal (fluid)
Disease: -any neurological symtom of weakness, -tingling, -numbness, -blurred vision -women 2:1 -upper motor neuron disease
MS
elftman theory? which Mid tarsal joint is the key to stability according to elftman?
MTJ locking and unlocking. CC is the key to stability
joint type in foot: Ellipsoid
MTPJ
soft palate, fauces and uvula
Mallampati score 2
soft palate and base of uvula
Mallampati score 3
soft palate not visible
Mallampati score 4
soft palate, fauces, uvula, tonsillar pillars
Mallampati score I
MESS score acronym
Mangled Extremity Severity Score
Ankylosing Spondylitis aka
Marie-Strumpell's disease
what is the carcinoma most frequently associated with chronic venous ulcers Marjolin's ulcer
Marjolin's ulcer (SCC)-Cloaca malignant degeneration
Dorsiflexory fusion of the 1st metatarsal-medial cuneiform joint
McEvenny-Caldwell
when is EKG recommened preop mcglamery? (3) other sources? "DICCCS"
Mcglamery 57: HO heart disease men >40 women >50 other sources: "DICCCS" DM, Ishcemic cardiac disease cerebrovascular dz, CHF, cr >2.0, smoking, lung disease
club foot on xray (3)
Mearys) > 15 (positive mearys seen in cavus foot types) Kites <15 Metatarsal stacking (indicates forefoot supination)
AFO height of the device
Measure from the plantar surface of the heel to the posterior apex of the patients calf Proximal edge of calf segment equals the measurement
which Isherwood position is used to see the middle facet of the STJ?
Medial Oblique Axial Position W202
which Isherwood position is used to see the anterior facet of the STJ?
Medial Oblique position W202
origin of quadratus plantae
Medial and inferior surface of calcaneus
DeVries Incision:
Medial longitudinal
which medicare coverage is supplemental
Medicare Part B, for which the policyholder pays a premium
6 months swelling distal toe, brown to black discolouration of the toe nail. Which type of cancer?
Melanonychia
how is the Bleck Classification drawn?
Met Adductus bisection of calc compared to 2nd digit
what angle is most important to evaluate Met adductus vs HAV? whatare the normal valuse for: -IM -hallux abductus -PASA-draw it -DASA- draw it -Hallux abductus -Interphaangeus -Met protrusion -Tibial sesmoid position
Met adductus angle for MA: normal 15 *IM 8-12 most important for bunionectomy eval* Hallux abductus 0-15 PASA 7.5-12 (left pic) DASA7.5 ( right pic) Hallux abductus Interphaangeus 10 Met protrusion 2mm Tbial sesmoid position 1-3
Statistic combination of data from several studies
Meta-analysis
Bebaxe shoe use (2) how is it adjusted (1)
Metatarsus adductus club foot (adjust using allen wrench) "BEBAX and rocksteady work with allen wrenches to fix club foot and MA"
flexor stabilization (pronated foot and aductovarus of 4th and 5th toes) occurs when during gait Flexor Substitusion occurs when during gait Extensor Substitution occurs when during gait
Midstance "midstance grips the floor with pronation and adductorarus 4th and 5th" Pre-swing Initial swing
Young women, can be asymptomatic. *Late systolic murmur with mid-systolic click.*
Mitral prolapse "PM click it or tickit"
Rheumatic fever, endocarditis, MI, prolapse. L. heart failure, then R. side failure. *Holosystolic, constant intensity, blowing murmur*
Mitral regurgitation "RM is holyo"
bacterial endocarditis what heart valve is most commohly affected? What other vinnet triggers are associated with bacteraial endocarditis
Mitral valve most common "Bacteria FROM JANE" Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail bed hemorrhage Emboli
EKG dx: Dropped beats that are not proceded by a change in lenght of the PR interval (as in type 1), treated with a pacemaker
Mobitz type II
Morphine half life Codeine has a half life of Tramadol has a half life of Hydrocodone has a half life of which one is shortest? which one is longest?
Morphine has a half life of approximately 1.5--2.5 hours. (peak is 30-60 min) Codeine, Tramadol, and Hydrocodone all have longer half-lives. Codeine has a half life of 3 hours. Tramadol has a half life of 6.3 hours Hydrocodone has a half life of 4 hours.
difference between AP and Ankle mortis view
Mortise: can see talar dome and medial and lateral gutter clearly AP: can see lateral talar gutter becuase there is overlap
is Factor V Leiden a bleeding disorder or hypercoagulation disorder? what does it affect.
Most common *hypercoagulable state*, mutated factor V that is resistant to , Protein C and Protein S cleavage. Increased risk of thrombosis
19YO F LE weakness and 10 minutes of blindness - cause?
Multiple Sclerosis
Scanning speech/nystagmus → seen in
Multiple sclerosis
spastic CP treatment of equinus
Murphys procdure
Most common PACU complication
N/V
-calculate normal calcaneal stance position -calculate TI
NCSP= STJNP + TI TI=Max pronation + Eversion
Treatment for Pseudogout
NSAIDS Imbolization analgesics
Treatment for Psoriatic Arthritis (3)
NSAIDS sulfasalazine steroids
Treatment for Reactive arthritis
NSAIDS tetracycline following chlamydial infection
anion gap equation
Na - (Cl +HCO)
Signs of salicylate toxicity (5)
Nausea, vomiting, diaphoresis (sweating) tinnitus, tachycardia
Watson jones stages for what tarsal bone? most common stage?
Navicular fractures 1: Tuberosity fx: PT tendon avulstion *2: Dorsal lip fx: most common* 3a: Nondisplaced body fx, 3b: Displaced body fx. 4: stress fx. intraarticular,
Scwannoma types
Neurofibroma: rubbery on palpatio Neurilemmoma: solitary, painless
picture of nodule and when you push on it it retracts into the skin, what is it?
Neurofibromatosis
plate: protectes interfrag compression screw at the fracture site from normal bending, and rotational axial loading forces
Neutrilization plate
A skin finding in which top layer of skin slips away from lower layer when slightly rubbed. Seen in Bullous Diabeticorum
Nikolsky sign
WEBER & CECH classification? which has the greatest chance for healingf
Non-union *Hypertrophic callus: * "Hyper animals" -elephants foot large callus (greatest chance for healing) -horse hoof (minor callus) -oligotrophic (absent callus) *Atrophic: No callus* -torsion wedge (one end healed, other end not) -comminuted (intermediate frag is necrotic) -atrophic (end result of non-union, both ends are osteoporotic) -Defect (loss of fragment between two ends M6
normal INR w and w/o warfarin
Normal INR without Warfarin: 1 INR on warfarin: 2-3
2 risk assessments scales for pressure ulcers
Norton Scale Braden Sclae
Synvisc, hyalgan and orencia are biopharmaceuticals used to treat
OA
causes for marrow edema on MRI (2)
OA fractures
apatite crystals
OA inflammatory arthritis calcific periarthritis
Aspercream is a topical used as relief for (4)
OA, tendonitis, ligament injury, any inflammation
"osteoPHYTE the EBURN from DJ MICE b/c he is ASyMMETRIC NARROW minded
OA: osteophytes eburnation DJD joint mice in articular space Asymmetrical joint space narrowing
bone marrow infection
OM
cierny mader classification
OM classiication that combines anatomical with phyisiological causes
Waldvogel classification? most common?
OM occurs in one of 3 ways: 1. hematogenous (via bloodstream) most common in general, but not in the foot. 2. contigous (adjacent ST) 3. direct inculation (trauma or surgical) W269
difference between obstructive and restrictive lung disease
Obstructive: obstruction of air flow resulting in air trapping in lungs Restrictive: restricted lung expansion causes decrease lung volumes
what does OSHA stand for
Occupational Safety and Health Administration
Amelonotic melanoma
Occurs when a melanoma arrises from a melanocye devoid of pigment, may occur from any of the 4 most fommon types of melanoma
Ogden VII: Ogden VIII: Ogden IX:
Ogden VII Epiphyseal Ogden VIII metaphyseal Ogden IX periosteum stripping
Oligodendrocytes vs Schwann cells
Oligo: CNS schwann: PNS
What 2 incisions are made for triple ollier incision use
Ollier: (pic) tip of lateral mall to base of 4th met to access STJ, CCJ Medial: medial gutter to 1st met base to access TNJ and TC fixation
Describe Laminated periosteal reaction? seen in what bone tumor?
Onion skin appearance - Ewings Sarcoma
Onychatropia: Onychauxic: Onychia: Onychoclasis: Onycocryptosis: Onychogenic: Onychoheteroptia: Onychomadesis Onycophosis: Onychopuntata: Onychorrhexis: Onychoschozia: Onychotillomania:
Onychatropia: atrophy (pic) Onychauxic: thickening "cake makes you thick" Onychia: inflammation of matix Onychoclasis: breaking "clashing nails breaks them" Onycocryptosis: Ingrown Onychogenic: producing nail substance Onychoheteroptia: nail in abnormal place Onychomadesis: seperation nail from bed "seperate from mother n law" Onycophosis: callus in nail groove Onychopuntata: Pitting Onychorrhexis: brittle "brittle nails are easily recked" Onychoschozia: splitting/flake in layers "schozia are flakes" Onychotillomania: picking at nail "manic picking nails"
cotton flatfoot correction
Open dorsal wedge of 1st Cuneifom
Bone tumor that resembles and was once considered a large osteoid osteoma?
Osteoblastoma
Voorhoeve's dx. Linear band of dense bone, hip, unknown etiology,metaphysis/diaphysis
Osteopathia Striata
spotty bone dx, multiple dense areas. epiphysis/metaphysis only.
Osteopoikilosis
Contraindications for US (7)
Over spinal cord, open epiphyseal growth plates, bony prominences, fractures and acute infections, menstruating uterus, laminectomy, vascular disease, insensate skin metal implants, pacemakers
Lag by design omits
Overdrill
depolalization of atria depolarization of ventrical repolarization of ventrical
P QRS T
Lauge hansen lateral spike fracture
PAB stage 3: transverse or comminuted fracture of fibula at the level of the syndesmosis (lateral spike)
dependant rubor vs rubor with elevation
PAD vs Infection
Reverdin bunionectoomy is primarily used for increased ______angle
PASA
antagonist of the TP
PB
which cancers are most likely to metastisize to the bone: (5)
PB KTL Prostate Breast Kidney Thyroid Lung
most common preventable hospital death
PE
Lauge hansen masioneuve
PER 3 "PER is worst kind just like Mason"
action of foot lumbricals (3)
PF proximal phalanx Extend middle and distal phalanges Contraction causes tightened WING and slacken SLING components of the extensor hood
which is faster absorbed: PGA vs PLA
PGA is faster, these are the 2 types: PGA: polyglycolic acid, PLGA: poly lactic-co-clycolic acid
what is peroneus longus tendon transfer? indication?
PL is released at cuboid and inseerted to the lesser tarsus or bast of 3rd met Indicated for drop foot or pes cavus
PPO cost, covergae and restrictions
PPO: -higher price tag and probably a deductible -greater coverage -more flexible and provide
INR is the standard value for? PT or PTT
PT
treatment for ankylosing spondylitis
PT NSAIDS
Weinraub and Heilala classification for what condition?
PTTD
most common reason to prescrive Richie or Arizona brace
PTTD
cobb procedure
PTTD: medial 1/2 of anterior tibial tendon is transferred thorugh a drilled hole in the medial cuneform or navicular. and reconstruction of PTT is preformed -best procudre for stage 2 PTTD
Johnson and strom classification which stages are flexible vs rigid? which stages involves What is helbings sign
PTTD: stage 1: flexible mild degeneration tx conseravative, tendon debridment stage 2: flexible tendon degereration tx tendon transfer, RF arthrodesis, A-<30% TN head uncovering, B- >30% TN head uncovering stage 3: rigid= ruptured tendon and elongated, weak heel rise tx triple arthrodesis, AFO bracing stage 4(myerson): rigid = same as 3, rigid ankle valgus tx TCC or pantalar, AFO bracing Helbings sign: Positive is when there is a lateral concavity of the achiles. (no pull of PT means foot has un-opposed eversion) (pic)
General term for a Patient with decreased pulses, pain after walking acertain distance, decreased hair growth
PVD
MRI contraindication (7) -is internal fixation CI with MRI?
Pacemaker, metal clips, metal valves, metal sints, silvers of metal embedded into eye, choclear implants, stents, internal fixation NOT CI with MRI, but recommended that hardward be in for at least 6 weeks
Allodynia vs hyperalgesia
Pain from a stimulus that doesn't normally cause pain an extreme, exaggerated reaction to a stimulus which is normally painful
pseudo-claudication
Pain when walking that mimics vascular claudication but is due spinal stenosis
Lister's Corn
Painful corn in lateral groove of the 5th toe from varus rotation of phalanx
Inflammation involving the folds of tissue around the nail
Paronychia W284
what are the medicare plans A-C?
Part A covers inpatient care, skilled nursing facility, and in limited circumstances, at home nursing . Part B covers lab tests, surgeries, and doctor visits including *podiatry*. Part C covers additional benefits, such as vision, dental, and hearing, and many include prescription drug coverage
SLE radiographic findings? *what would be found on peripheral blood smear*
Periarticular osteopenia and soft-tissue swelling without erosions. *hemotoxilin and eosin, rosetts*
65 degrees of dorsiflexion are required at the 1st MPJ for propulsion, however only 30-40 occur passively. The rest comes from what?
Peroneus longus.
calcaneus ABD and EV, talus PF. Flexible: tight achilles, reducible. Rigid: coalition, bone blocks, nonreducible. Increase talar declination, decrease calc inclination, increase lateral talocalcaneal angle, midfoot faults, anteriorly displace cyma line. Obliteration of sinus tarsi, decrease talar head coverage, decrease MAA.
Pes planovalgus
Epinephrine use is contraindicated in pts with
Pheochromocytoma
Photoelectric effect: vs comton effect
Photoelectric effect: this occurs at lower kVp when an x-ray photon colides with a lower shell elctron. and the elctron is ejected and another highter shell elctron fills its space, releasing enery. This is beneficial to the image, but results in greater absorption of radiation to the pt (pic) The compton effect occurs when an x-ray photon interacts with an outer shell electron. The compton effect occurs mostly above 80kVp. It cuases less radiation to the pt and is detrimental to the image
Inflammation and thickening of synovial lining. Hip or knee, increase synovial fluid production, joint edema, pressure erosion, pigment due to hemosiderin laden macrophage. MRI preferred diagnostic tool. Tx: synovectomy.
Pigmented Villonodular synovitis
make up of Zosyn
Pipercillin/Tazobactam
Amputation: Sectioning the talus and calcaneus in line with the anerior margin of the tibia therby preseving the posterior portion of the calcaneus, heel wiehgt bearing surface and insertion of the achilles tendon
Pirigoff amputation
what is the difference between cortical and cancellous cortical is _____x stiff than cancellous bone?
Pitch =distance between each thread. (cortical has smaller pitch so that it can engage more of the bone 5-10x
What type of scalying papular disease has a Christmas tree pattern in which patches on the back radiating down the spinal column A big patch seen in this is know as
Pityriasis Rosea Herald patch
hoke flatfoot correctio
Plantar base wedge athrodesis of navicular, 1st and 2nd cuneiform, TAL
miller flatfoot correction
Plantar base wedge of Navicula-1st cueniform and 1st cuneiform metatarsal fusion
structural vs positional HAV
Positional bunions= bone growth, Structural bunions= shifting out of position.
Root's theory for HAV: 5 main components for primary
Primary: Pathobiomechanics: compensation for -FF/RF varus/valgus, -equinus, -pronation (PL losingstabilizing pull), -MPE, -hypermobile 1st secondary: trauma/iatragenic, NM, RA
What are the ester local anesthetics?
Procaine, cocaine, benzocaine. Metabolized by plasma esterases. (All have only one "i")
Name several ways the body absorbs shock upon heel-strike
Pronation-dissipates shock calcaneal fat pad knee menisci knee flexion trabecular bone within calcaneus muscles vibrate
difference between proptosis and exopthalmos
Proptosis in the same reference is defined as exophthalmos. Proptosis can describe any organ that is displaced forward, while exophthalmos refers to only the eyes
micro bug that causes OM seen in durg addicts vs micro bug that causes OM seen in healthy adults and children
Pseudomonas vs S aureus
Ecthyma gangrenosum micro
Pseudomonas aeruginosa
phisiology of malignant hyperthermia
Pt is exposed the anestheic agent or muslce relaxant (SHID), the calcium stored in muscles are released causing muscles to fasciculate and contract. The rapid contraction causes muscle metabolism to be accelerated and causes a high fever, muscle breakdown, and acidosis.
bronchogenic carcinoma. digital clubbing, symmetrical arthritis, Linear periostitis (inflammation of periostium) of long bones: "Double strip sign" on bone scans, look like 2 cortices. Metaphyseal and diaphyseal
Pulmonary Hypertrophic Osteoarthropathy (PHO)
which class of drug has been known to cause Achilles tendon ruptures
Quinolones ciprofloxacin (Cipro), lomefloxacin (Maxaquin), norfloxacin (Noroxin), ofloxacin (Floxin), moxifloxacin (Avelox) levofloxacin (Levaquin)
Seropositive Arthritis (4)
RA SLE Active Hepatitis Sjogren's syndrome
Boutonnier deformity and swan neck vs Bouchards nodes and herberdens nodes
RA vs OA (DJD) M8, W171
Felty syndrome
RA, splenomegaly, neutropenia may present with pigmented spots on lower extremity and non healing ulcers
what does NCSP represent?
RF deformity
experimental, prospective study which subjects are assigned to a treatment or control group. Randomization ↓ bias and confounding. blinded (patient does not know to which group he/she is assigned) or double blinded (neither patient nor researcher knows the group assignment).
Random controlled clinical trial study
Fungal culture using a DTM (Dermatopyte test medium), requires 10 days to grow. what color does the medium have to turn to be diagnostic for dermatophytes?
Red
Bier block
Regional anesthesia in which the anesthetic agent is injected into a vein when there is a proximally located tourniquet
Heyman, Herndon, and Strong Procedure
Release of all the ST structures at Lisfranc joint *except lateral and plantar* ligaments
examples of comorbities contribute to wound failure in DM pts (5)
Renal failure Uncontrolled DM organ trasnplant anemia CHF
acidosis/alkalosis chart
Resiratory acidosis >40 Metabolic acidosis <40 Respiratory alkalosis<40 Metabolic alkalosis>40
logrocino bunionectomy
Reverdine + *Loison Balcescu* corrects IM and PASA
Limberg flap aka? V-Y plasty % distance increase?
Rhomboid: longitudinal axis is PARALLEL to line of minmal skin tension (pic) 20%
examples of supramalleolar AFO
Richie and Arizona
Most stable loop in cerclage? size range for cerclage wire?
Right angle loop most stable loop. 26 and 28
which is better for MA deformity rigid vs flexible
Rigid: low reoccurance rate
Rinne test vs Weber test
Rinne: vibration on mastoid to sound in same ear Weber: center of forhead
sievert
Roentgen dose equivalent
Indication for cocked up 5th toe
Ruiz-More
Lauge-hansen medial malleolar fractures?
SAD2 Vertical SER 4 transverse PAB1 Transverse PER1 transverse
steroid flare
SE from injectable steroid its a transient increased pain several hours after injection but goes away after 24hrs
propofol: SE? color? use? allergy?
SE=hypotensive effects on the heart, arteries, and venuels= so cant use it with bad heart condition color=milky white use=induction/maintainance allergy=egg
Triplane fracture
SH IV:
muscles of the rotator cuff
SITS Supraspinatus Infraspinatus Teres Minor Subscapularis
photosensitivity pericarditis nephritis
SLE
Extensor hoot apparatus WING and SLING
SLING: proximal WING: distal (plantar attachement of lumbrical)
SNEPPEN Classification
SNEPPEN - Talar Body Fractures Type 1 - OCD 2A - frontal shearing force 2B - sagittal shearing force 2C - transverse shearing force Type 3 - posterior tubercle Type 4 - lateral process Type 5 - crush
cardiac ischemia on EKG
ST segment depression and T wave inversion
Broca/Malgaigne classifcation
STJ dislocation 1. medial displacement 2. lateral displacement 3. Anterior/posterior displacement
Broden View is used to evaulate?
STJ posterior and middle facet
NCSP calcuation
STJNP + Tibial Influence
Samilson procedure? Grice procedure?
Samilson: sliding type calc osteotomy with lateral incision indicated for polio pt with very high CIA Grice: extraarticular STJ arthrodesis commonly used in CP
systemic granulation disease, unknown etiology, noncaseating granulomas. black females and Norwegians; target lung esp. age 30-40. tx with systemic steroid.
Sarcoidosis "Sarcasim=non serious"
Non-caseating granulomas vs caseating granulomas
Sarcoidosis vs TB
Lasegue's sign
Sciatica: pain with knee extened and hip flexed
Laségue test
Sciaticia: Straight leg raise produce symptoms
nerve injury classifications: (2)
Seddon classification sunderland classification
What makes up T1 vs T2 MRI on the long/short/ TE/TR graph.
Short TR <800 and short TE <30= TI long TR >800= balanced T2 TR (800). TE (30)
what does STIR stand for
Short-T1 Inversion Recovery (type of fat suppression used to nullify the signal from fat to allow greater visulaization of other tissues)
morton foot what is the difference between a metatarsal pad and a dancer pad
Shortening of the first metatarsal in relation to the second metatarsal -> brachymetarsia Excessive pronation of the foot, pain in the ball and arch of the foot w/ internal hip rotation and functional shortening of the leg tx: foot orthotics w/ metatarsal pad under the first toe and metatarsal to redistribute wt bearing to first toe difference: metatarsal pad offloads mets, dancer pad offloads 1st met
Tramadol SE
Similar to opioids. Decreases seizure threshold. Serotonin syndrome. (increased serotonin in CNS by inhibiting serotoinin reuptake)
HR increases with inspiration and decreases with expiration
Sinus arrhythmia
Schirmer test is for what? positive test?
Sjorgen's syndrome Litmus paper is placed on eye for 5 min, <5mm of wetness= positive schirmer test
a pt presents with a Long-term autoimmune disease that affects the body's moisture-producing glands. Primary symptoms are a dry mouth and dry eyes. Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, feeling tired, muscle and joint pains, and thyroid problems. A Schirmer test is performed to rule in/out?
Sjögren syndrome
this aquired from gradual compensaion of a metatarsus varus that develops with weight bearing or improper manipulation and castin
Skewfoot
Skin graft vs muscle graft
Skin graft contains vascular supply vs muscle graft contains vascular supply and muscle
A patient underwent surgery to correct rigid medially deviated second hammertoe deformity with long metatarsal. In what position should the toe be bandaged postoperatively to prevent complications?
Slightly plantarflexed because the toe will have a tendency to dorsally contract postoperatively.
Osteitis of Garre
Slow infection allow increase bone production and density to combat organism
3 Cerebral palsy types
Spasitc (70%) (most common) vs Athetoid (20%) vs Ataxic (10%)
Shown below is a radiograph of a 14-year-old male who fell six feet and presented to the emergency department two hours after the injury. Which of the following diagnostic tests is the most important to order?
Spine radiograph
Split thikness skin graft -thickness -encorporation -shrinkage -pigmentation/cosmetic appeal -susceptible to trauma -fail rate -cosmetic appeal
Split thikness skin graft: -epidermis/partial dermis, -increased SA, -increased drainage, -shrinks, -abnormal pigmentation, worse -more suseptible to trauma -lower fail rate
Koilonychia nail systemic pathology
Spoon nail, iron deficiency, inflammatory skin dx.
most common pathogen for fungal arthritis
Sporothrix shenckii
PAB ankle fracture (3)
Stage 1: eversion type of injury, there is a transverse avulsion fracture of the medial malleolus or rupture of the deltoid ligament Stage 2: rupture of AITFL and PITFL Stage 3: short oblique fibular fracture occurs at syndesmosis
PER ankle fracture (4)
Stage 1: transverse avulsion of medial malleolus or rupture of the deltoid ligament Stage 2: rupture of AITFL(Wagstaffe or Tillaux) Stage 3: high fibular fracture (maisonneuve Stage 4: rupture of the PITFL or a Volkmann's fx
Study with ages ranging between 3 to 64. How should it be documented?
Standard deviation and mode
Epidemiology definition
Stduy of incidence, distribution, and possible control of diseases and other factors relating to health.
which stewart classification is usally associated with peroneus brevis avulsion? aka
Stewart 3 (most common 5th met base fracture) aka pseudo-jones fracture
What is a Keith needle?
Straight needle
how are the branches of the superficial peroneal nerve?
Superficial peroneal n: IDCu and MDCu IDCu: LDCoDb, MDCoDb MDCu: DCoDb, DDb
Keck and Kelly osteotomy
Surgical treatment of Haglunds deformity W293
Emery-Dreifuss Muscular Dystrophy (EDMD)
Symptoms begin in teenage years with toe-walking, rigid spine, face weakness, hand weakness and calf hypertrophy. -shoulder and LE -bradycardia, palpitations -may need cane or walker
Pigmented villanodular synovitis in ankle on x ray
Synovitis of the Ankle with Extensive Bone Involvement
Superficial white onychomycosis caused by
T mentagropytes
Distal and proximal subungual onychomycosis caused by
T rubrum
Hypokalemia EKG
T waves flatten; U waves
most common dermatoyphyte infection causing tinea pedis
T. Rubrum "Rude bro you gave me tinea"
MRI fracture T1 vs T2
T1: decreased signal T2: increased signal
how quickley the transverse magnitization dcays is what type of MRI?
T2
only Topical steroid that causes vasocontriction
TAC: tetracaine, adrenaline, cocaine mainly used in dentistry
Tibial nerve blocks are most useful for (5)
TAL gastroc recession Achilles tendon tear repair clubfoot release pediatric pain manegment Mcglamery 67
Gastrosoleus equinus surgial procedure (-) silverskoid test ( cant pass perpendicular with knee flexion) vs Gastrocnemius equinus (+) silverskoid test (can pass perpendicular with knee flexion)
TAL (Z plasty, Hauser, White, Hoke, conrad frost) vs Gastric recession (vulpius, strayer, fulp and mcglammary, baker, silverskoid)
Best treatment to lenght heel cord with a negative silverskoid test
TAL becuase even with knee flexed where the gastroc could be the culprit, the AJ dorsiflexion doesnt improve, there for its an isolated achillies tendon problem, thus the TAL (negative test= cant AJ 0 degree with knee straight AJ 10 degrees with knee flexed)
Recently returned from Haiti and you have Haemophilus. What disease
TB
most common coalition
TC
gold standard for offloading a diabetic foot ucer
TCC
Pathology? FF adductus, RF varus, ankle equinus that creates skin folds. Congenital deformity with radiograph showing decreased Calcaneal inclinication angle Increased MAA, decreased Kite's angle. Talar headneck reletive to the body is increased addction and increased plantarflexion. Talus and calc almost parallel on Lateral. Order of casting for correction is: correct the Vavus deformtiy first then correctFF adductus then , RF varus,and then last cast out ankle equinus. -How is the cavus dermormity corrected in
TEV (club foot) taileps=talus + pes (CAVE=cavus, adduction,varus, equinus) correct the cavus deformity by supinating and dorsiflexing the 1st met to align with forefoot. common mistake is manipulatint the calcaneus (kites error) in that prevents abduction.
Girl with lower extremity weakness, 10 minutes of blindness, diagnosis?
TIA
Which joint if fused would cause the most decrease in motion?
TN
"aceabulum pedis" referes to what joint
TNJ
TNJ vs CCJ and Midtarsal joint axis relationship
TNJ: longitudinal (75,15,9) CCJ: Oblique (38,52,58)
Fracture classifications: Hawkin's? what is the canale view?
Talar neck fractures "hawks neck is fractured" modified AP with foot pronated 15 degrees to evaulate talar neck fractures.
what makes up the midtarsal joint
Talar-Navicular Calcaneal -Cuboid
club foot defomrity? Talus? Navicular? Forefoot? Rearfoot?
Talus= medial plantar diviation Navicular= medial subluxation Forefoot= adducted Rearfoot= varus and equinus
Difference between: Tc-99MAA vs Tc99MDP
Tc-99MAA: capillary bed fussion in DM, ascess healing potential in ishcemic ulcers "MAA is like MMA lots of blood" vs Tc99MDP: bone metabolism, stress fracture, osteoblastic
Best imaging for stress fractures (2)
Technetium 99 bone scan - may be positive 2-8 days after symptoms X-ray can take 14-21 days for bony callus
Tagged molecule is HMPAO for what type of bone scan? what does it stad for?
Technetium-99m Hexa-methyl-propylene-amine Oxime
Bridging therapy is basically the..... and is important to prevent..... How is bridging therapy done: 1. Stop _______? 2. Start ________? 3. Confirm______? 4. Restart ______? 5. Restart ______? 6. Discontinue ______?
Temporary administration of an anticoagulant, important to prevent clots 1. *Warfarin* 6 days preop if INR is 2-3 2. *LMWH* 36 hours after last dose warfarin 3. *INR* is will be between 1.2-1.5 at this point 4. *warfarin at regular dose* sx day 5. *LMWH* within 24hrs post op 6. *LMWH* 2-3 days post op until INR returns to therapeutic for 2 days in a row
Amputation: for total nail removal, removal of 1/2-1/3 distal terminal phalanx. Indicated for subungal, glomous tummor, mallet toe, macrodactyl
Terminal symes amputation M47
level of disease prevention: trying to improve your quality of life and reduce the symptoms of a disease you already have.
Tertiary
allen's test
Test for arterial blood flow, constrict artery of interest, press on skin, release artery and watch for color to return.
degree of frostbite: -may have months of erythema -subcutaneus layer -chronic edema and thawing recovery phases
Third degree
EKG dx: The atria and ventricles beat independantly of each other. Both the P waves and QRS complexes are present, although the P waves bear no relation to the QRS comples, atrial rate is faster than ventricular rate. treated by a pacemaker
Third degree heart block
raising the kVp will increase the negativity of the cathode and the negativity of the anode, which causes?
This willcause the electrons to hit the anode with a much *greater force*. The result will be an x-ray beam with a *greater penetrating power*.
Axial MRI of talar dome, which tendon is most anterormedial
Tib Anterior
Immediate branches of Sciatic nerve
Tibial Common Peroneal
Cardinal principles of radiation protection (3)
Time, distance, shielding
What is a PET scan used for?
To assess for cell death it shows the metabolic process in body. Helpful in cellular activity in cancer
rule of 15% lenghten scale of contrast (more shades of grey) vs shorten scale of contrast (less shades of grey)
To lengthen the scale of contrast Decrease the mA's by half and increase the kVp by 15% "increasing kVp increases GLAD PB" To shorten the scale of contrast Increase mA's by 2 and decrease the kVp by 15%
Hubscher Maneuver aka
Toe test of jack
Lopresti (Rowe 4&5) Tongue vs Joint depression
Tongue: vertical force continue vs Joint depression: the direction of the force is more oblique aiming posteroinferiorly
If orthotic has a c shape when casting, what does that mean?
Too much supination at stj
arthroesis planes of treatment transverse plane (2) frontal plane (1)
Transverse plane: self locking (Valleni, MBA), direct impact (Sgarlato mushroom, Pisani) Frontal plane: axis altering (STA peg)
describe the trifurcation of Extensor digitorum longus
Trifurcatin occurs at the head of proximal phalanx EDB attaches at the base of proximal phalanx 1 central slip inserts into the dorsum of base of middle phalanx 2 collateral slips unite at the head of middle phalanx and insert into the dorsum of the base of the distal phalanx
(T/F) The talus is wider anteriorly than posteriorly?
True
T:F Public health law requires disclosure of possible HIV infection to other sexual partners
True
T:F Steinmann Pinns and K wires can be threaded
True
T:F When muscles necrose they do not bleed when incised
True
T:F Epidural anesthesia should be considered over general anesthesia in pts who may be at risk for DVT and will be hospitalized for post op manegment
True Mcglammary 98
T:F Dermatophytes live on only dead cells? T:F Dermatophytosis infection elict an immune infection? T:F Dermatopytosis can become a systemic infection
True True False W245
T:F Its best to avoid surgery with CPRS pts
True treatments include: local anestheic inorder to do *aggressive PT* or massage, ROM exercise, US, splinting,contrast baths, TENS, acupuncture, nerve blocks, and psychotherapy. *AVOID SX* if at all possible
Angiolipoma
Tumor that contains numerous small blood vessels with fat
Stewart comminuted fracture is most likely which type
Tye 4 (Intra-articular
Tendonitis vs. Tendinosis
Type 1 collagen, inflammation, white glistening Type 3 collagen, degenerative, gral dull
cornate navicular aka
Type 3 lawson navicular ossicle
Salter-Harris Fracture: Oblique fracture through the epiphysis and metaphysis/diaphysis. Intra-articular
Type 4
Salter-Harris Fracture: Crush Injury of the growth plate which can cause shortening and is associated with poor prognosis
Type 5
Total homolateral incongruity
Type A Hardcastle
Lauge hansen relationship to Danis Weber: Type A (1)
Type A: SAD 1 Transverse avulsion fx of lateral malleolus at or below ankle.
Essex-Lopresti classification Type A vs B
Type A: Tongue fracture: talus is driven straight down into neutral triangle Type B: Joint Depression: vector of force is more anteroposterior (see pic with arrows anterior or posterior)
Partial Incongruity of 1st only (medial displacement)
Type B1 Hardcastle
Lauge hansen relationship to Danis Weber: Type B (2)
Type B: SER2, PAB3 Spiral fx of lateral malleolus at the level of tibial plafond (most common)
Lauge hansen relationship to Danis Weber: Type C (1)
Type C PER3 High fib fx, tibio-fibular syndesmosis rupture. (maisonneuve fracture)
Divergent partail with 1st displaced and 2,3,or4 mets displaced
Type C1 Hardcastle
Divergent total with 1st displaced and 2-5 dispalced
Type C2 Hardcastle
-Kuwada classification Type? -Treatment for each type? 23 y/o, ATR, 2cm defect
Type I: partail tear <50% (non operative) *Type II: <3 (end to end repair)* Type III: 3-6 (tendon transfer, graft) Type IV: >6 (gastroc recession)
Gustio and anderson with minimal to no periosteal striping
Type IIIA
Gustio and anderson with periosteal stripping
Type IIIB
Gustio and anderson with arterial injury
Type IIIC
Xray: if in calc occurs at the neutral triangle on xray may see fallen fragment sign. well defined lytic lesion w/out central mineralization MRI: huge white thing on T2 (hyperinesnse T2), hypointesne T1
UBC
increased leukocyte esterase
UTI
What is the difference between compensated and uncompensated equinus?
Uncompensated is usually congenital(Patient walks on toes, hypertrophic calves, STJ supinated, walking plantarflexed, smaller steppage gait, RF inverted) Compensated is when the patient overpronates to get more dorsiflexion at the midfoot.
fallen fragment sign
Unicameral Bone Cyst
Following the rule that all pts may possibly have HIV, Hep B etc is known as
Universal precautions
Kenzlee gets this type of rash with her mild allergy
Urticaria (hives)
Phonophoresis vs Ionotphoreses
Uses *ultrasound* to drive topical anesthetics, anti-inflammatories, muscle relaxants into tissues vs Uses direct *current* to drive topical anesthetics, anti-inflammatories, muscle relaxants into tissues
ASA class? -ruptured aortic aneyrism -cranial bleeding -massive trauma -sepsis syndrome with hemodynamic instability hypothermia
V (not expected to live witout operation)
PMMA drugs (3)
Vancomycin Aminoglycosides: (tobra, genta, ami,) Cephalosporins "VAC the PMMA drugs"
EKG Dx: A completely erratic rythm with no identifiable waves
Ventricular Fibrillation "VFib is eratic"
Hyperechoic in Ultrasound
Very bright on the picture or very echoic: bone, scar tissue, tendon, ligament, nerves, ulcer sinus tract
Hypoechoic in Ultrasound
Very dark on the picture or low echoic properties: muscle, ulcerations, inflammation, tendon teears
common peroneal nerve block location
Very superficial, 1-2 cm deep. Palpate fib head. *Enter 2.5 cm distal* to fib head. 3-6 cc of local.
why is joint sepsis not possible in kids ages 1-16 years old
Vessels do not penetrate the growth plate, and most joint sepsis is caused by hematogenous spread
Beau's lines
Visible depressions running across the width of the natural nail plate, often associated with *nail trauma*
classifications for DM (4)
Wagner Knighton University of Texas NPUAP Pressure ulcer
nerve sclerosing chemical neurolysis moa
Wallerian nerve degeneration via dehydration
Dermatofibrosarcoma protuberans
Well-differentiated, primary fibrosarcoma of the skin Slow growing, locally aggressive, rarely metastasize
Explain how a cavus foot type can have "pseudo"/osseous equinus
With cavus, the foot is more supinated. SO the talus will be more dorsiflexed and abducted. If the talus is already dorsiflexed, it does not have as much range of motion left for dorsiflexion at the ankle joint. So it can be considered pseudo equinus. The muscle itself isn't tight, it is the lack of motion at the joint.
40% hematoma under nail - drain vs nail avulsion vs 20% nail apparatus involved in an ingrown toenail
With hematomoc: avulse if >25% hematoma or fractured vs With nail involvement: <25 nothing, 50% drain, >50% avulse.
Why does overpronation cause secondary equinus?
With overpronation the calcaneus is everted, shortening the length of the achilles. With time this becomes contracted
Bundle of Kent aka and symtoms
Wolff-Parkinson-White syndrome: Symptoms can include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope
modification to austin that shortens and platarflexes met head
Youngswick modification
What is an injunction?
a court order ordering the defendant to do or not do a particular thing
What is a subpoena duces tecum?
a court summons ordering the recipient to appear before the court and produce documents or other tangible evidence for use at a hearing or trial.
Pitting Corrosion
a form of localized corrosion that creates pits form on metal surface
Triplane wede
a heel wedge thickest at its anteriormedial edg, sued to supinate the foot
talocrural angle? normal?
a line drawn parallel to tibial plafond second line dran tips of malleolus 83 +/-4
What is plasmapheresis?
a method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells, and transfusing the cells back into the bloodstream. It is performed especially to remove antibodies in treating autoimmune conditions.
implied contract
a pt presenting to be treated but payment is not discussed, the doctor is entitled to payment
delirium tremens.
a serious form of delirium due to *alcoholic withdrawal* after a period of sustained intoxication
define assault
a threat of physical harm
stress radiograph talar tilt what ligaments does it indicate injury if positive?
abnormal if tilt >10 degrees alone or >5 when compared to contralateral side aka stress inversion for ATFL and CFL
Ecrodactyly
absence of 2 or more rays "cleft foot" or "lobster foot"
Define phocomelia
absence of proximal limbs such as hand and feet attache directly to trunk.
reason to calculate true IM angle
account for metatarsus adductus becuase with a MA foot the IM look larger
which melanoma occurs most often on feet and hands, nails
acral lentiginous melanmoa if in nails, begins in proximal nail fold W256
the following symtoms describe: Severe fatigue. Unintentional weight loss. Gastrointestinal problems, such as nausea, vomiting and abdominal pain. Lightheadedness or fainting. Salt cravings. Muscle or joint pains. hyperpigmentation of skin labs: hypoglycemia anemia decreased Na and PB increased K decreased adrenocortical function
addison disease-decreased adrenocotical function
skew foot deformity: forefoot? hindfoot?
adducted forefoot valgus hindfoot
Pulled groin muscle
adductor due to forced abduction
General: Waterhouse-Frederichsen syndrome
adrenal insufficicney
All adult fx are _______ , only ped has ________ fx
adults: complete peds: incomplete or complete
Rheumatic fever
affects mitral valve most often "JONES" Joints, nodules, erythmea, Sydenham chorea -Aschoff bodies
MESS score categories (4)
age ischemia shock bone/ST injury
contraindiations for metformin (2)
age >80 serum cr <1.5 male or >1.4 female
neutropenia. aka
aka agrunlocytosis: deficiency of neutrophils
Definition of galvanic corrosion
aka dissimilar metal corrosion refers to corrosion damage induced when two dissimilar materials
Periungal fibroma aka
aka koenen tumor, seen around nail bed
what doe all these procedures hae in common? Addonte and Petrich and Dull Kelikian McKeever Brown
all are modifications to prevent toe retraction
increase in basophil and eosinophil
allergic reaction
normal values for NVC (nerve conduction velocity)
almost always >40 meters per second
Ionizing radiation
alpha, beta particles, gamma rays, xrays
define Monitored Anesthesia Care (MAC)
also known as conscious sedation or twilight sleep, is a type of sedation that is administered through an IV to make a patient sleepy and calm during a procedure. The patient is typically awake, but groggy, and are able to follow instructions as needed
what does all of these have in common: Ginger Biloba Ginseng Vit E garlic Fish oil
alter coagulation
Quinke's sign
alternating flushing and blanching of the nail bed d/t pulsation in the subpapillary arteriolar and venous plexuses->felt as capillary pulsation in the nail bed which can be encountered in aortic insufficiency
how does pericardial effusion appear on EKG
alternating height of QRS complex on all leads
make up of Unasyn
ampicillin/sulbactam
MESS score >7=
amputation
difference between anaphylactic reaction to the local anesthetic vs toxic reaction
anaphylatic reaction: -The lips & peri-orbital areas swell (angio-œdema) -agitated & there is generalised urticaria ('hives') & pruritus (itchiness), particularly of the hands & feet. -Other symptoms include abdominal cramps, nausea & diarrhœa Tightness of the chest, with wheezing & dyspnœa (difficulty in breathing) may occur -There may be a fall in blood pressure & a rapid thready pulse, which may be accompanied by flushing of the skin or rash. Toxic reaction: -drowsiness -tongue mouth paraethesia -Tinnitus, auditory hallucinations -muscular spasm -siezurre -coma -respiratory arrest -cardiac arrest
primary means of hemostatis during and after surgery
anatomic dissection technique
ganglion ultrasound
anechoic (black) well defined
Milkulicz angle aka
angle of inclination
Coxa Vara angle vs Coxa Valga angle normal for adult birth?
angle of inclinication <120 = coxa vara Angle of inclincation >130 = coxa valga (decreases fom birth 140) normal adult 120-130
Quigley Maneuver
ankle fracture reduction
cotton hook test
ankle mortise xray intraop, pull on fibula with clamp at level of syndesmosis and if there is no distraction=no syndesmotic inury 3-4mm lateral shift indicates syndesmotic instability
open pack position for ankle, 1st MTPJ, 2nd MTPJ
ankle: PF, 1st: DF, 2nd: PF
how often should OSHA exposure written plan be updated
annualy
calcanealnavicular coalition on lateral radiograph indicates?
anteather nose sign
CFL attachments
anterior border and apex of lateral mall to peroneal spine of lateral side of calc
forefoot varus compensation characteristics (4)
anterior break in cyma line Calcaneus is everted pronating foot forefoot on surface
compartemnt of leg m that is biphasic? (fires for both stane and swing of gait)
anterior compartment
Isherwood medial oblique position
anterior facet of STJ
Diffuse Idiopathic Skeletal Hyperostosis (DISH) most often affects which ligament in body
anterior longitudinal ligament
Shin Splint Causes (3)
anterior m overuse equinus lactic acid build up
shoe location: Vamp
anterior portion of the upper covering the forefoot and toes
nutation
anterior sacral tilt, posterior iliac tilt
exertional compartment syndrome most common compartments? (2)
anterior, lateral compartments
in vertical talus how are STJ facets deformed? hallmark?
anterior-absent middle-hypoplastic posterior-malformed pediatric deformity in which rigidty is the hallmark and it often occurs with athrogryposis
reverse thomas heel
anterolateral extension (rare)
3 most common portals
anteromedial anterolateral Posterior-Lateral
thomas heel
anteromedial extension made to the heel to provide additional support to the longitudinal arch and limit late midstance pronation
anteversion vs retroversion?
anteversion: femoral neck is anterior to the tanscondylar femoral axis= intoe. retroversion: out toe
reason for gentian violet (3)
antibacterial, antifungal, antihelminthec
Case with person experiencing fainting murmur?
aortic stenosis
atelectasis on Chest Xray
appears lighter than normal lung tissue. may be indicated by elevated diaphragm, mediastinal shift toward the area of atelectasis, or increased density and decreased volume of a lung area.
function of the whitman plate
applys pressure to the navicular with WB = *limit pronation*
Tc-99MDP use
areas of increased bone metabolism (fractures) and increased blood flow
symtoms other than GI for IBS (4)
arthritis Pyoderma gangreosum (treat with steroids). Violacious margins & lipodermatosclerosis ULCCCERS ulcers large intestine Contingous, Colorectal carinoma, Cryp abcess Exends proximally Red diarrhea Sclerosing cholangitis Vs Crohns
when to choose a hammertoe athroplasty over an arthrodesis
arthroplasty: reducible deformity arthrodesis: rigid
Reactive arthritis tetrad
arthrtis urethritis conjunctivitis mucocutaneous lesions
Fog on film. What does that mean?
artifact
how soon can a stress fracture be detected on a bone scan?
as early as 7 hours
when can a DMII take his regular insulin mediacations post op
as he can handle foot and water mcglamery 58
purpose for ASA guidlines
assess overal physcial health status preop
child has a cough after coming inside from being active outdoors indicitive for
asthma
flat line EKG aka T:F EKG is a poor indicator of ischemic heart disease
asystole TRUE
gait type for Werneky korsekov syndorome
ataxic
repetitive, involuntary, slow, sinous, writhig movements, especialy severe in hands? what conditions is it associated with?
athetosis seen in Huntington's disease, some with CP
HBO: atm? time? # dives? alternative?
atm: 2.4atm of 100% O2 time: 90 min # dives: 18-23 dives alternative: TCOM
DOC for celluitis that has E coli, Klebsiella, Pasteurella or Bacterodies
augmentin Medicine list
myasthenia gravis
autoimmune d/o affecting NMJ (-) ACh - long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. -Most commonly affected muscles are those of the eyes drooping, face, and swallowing. progressive weakness, women
Malignant hyperthermia has what kind of herditary
autosomal dominant
Peripheral neuropathy is damage to what part of the nervous system
axonal which causes sensory changes due to axaonal damage of small unmylinated nerves
where is the counter on a shoe
back 1/2 of upper touches heel
increased in monocytes and neutorphils
bacterial infection
difference between bard parker and beaver handle
bard parker for blades ranging from 9-25 beaver for blades ranging from 61-88, 312-316)
most common causes for myopathy (10)
barium swallow, autoimmune, endocrine, renal, alcohol abuse, steroids, retroviral meds, colchicine, PCP, heroin,
PEEK
basically plastic can be used in place of metal MRI ok, doesnt show up on xray
Rowe 2A
beack fracture (no achilles involvment)
Inverse square law radiology
beam intensity is inversilty proportional to the square of distance it travels (the further the beam progresses, the weaker the intensity)
what is dynamization in reference to External fixation
before ex fix is removed: all wires and pins are loosened and pt is allowed to weight bear to strenghten the bone and decrease fracture potential once ex fix is removed
single limb support described begins and terminates with?
begins with opposite foot toe off and terminates w opposite side heel strike
Where is spinal anesthesia injected?
below L2 to avoid spinal cord (L2-S1, L3-4, L4-5)
osteoid osteoma is malignant or benign? how to alleviate pain
benign. NSAIDS and asprin
POUR drugs (1)
bethanechol
Where does LPn run in foot
between 1st and 2nd layer
baxterns nerve travels where to innervate what m?
between abductor halluces and quadratus plantae and innervates abductor digiti minimi brevis. its the first branch off lateral plantar n.
Following a plantarflexion-adduction injury, a patient develops pain along the *anterior process of the calcaneus*. Dorsiflexion of the lesser toes against resistance is normal and without pain. The structure most likely involved is the
bifurcate lig
sulfonyurreas moa? 3 drugs?
bind to ATP dependant K+ channels on beta cells--> Calcium influx---> (+) insulin release -glyburide (2nd gen) -glipizide (2nd gen) -glimepiride (2nd gen) P72
if no change in venous statis ulcer size with unna boot or comprression in two months, what is next step
biopsy
Tibial varum: birth adults
birth: 5-10 adults: 2-3
MTA angle birth? 1 year age? 4 years age? Dx angle for Metatarsus adductus
birth? 25-30 1 year age? 20 4 years age? 15 (normal for adult) >20
Anechoic ultrasound
black fluid filed: ganglion cyst
__________study is the most appropriate and accurate research protocol for determining side effects of a medication
blind control
Color of nails pathology: blue: brown: Gray: Green: Red lunula: Yellow:
blue: antimalarial drugs, minocycline, hemochromatosis, wilson dz, silvernitrate brown: Addison dx hemochromatosis, gold therapy, arsenic, malignant melanoma, nelson synrome Gray: argyria (absorption of silver nitrate) Green: Psueomonas Red lunula: right side CHF Yellow: pulmonary dz and lymphedema
Charcot beaming of medial column - Purchase of screw through which aspect of the Talus?
body of the talus
bone healing strenght % vs tendon healing ____/5 strength
bone 100% tendon, looses one grade of strenth
what needs to be true to be considered a true AVN
bone death due to lack of blood flow (5) leg calf perthes Diaz Kohlers Freidburg Renandier and Trevor
T1 MRI image bone vs cortex
bone is white cortex is black
surgical repair for tendon rupture (3)
bosworth bugg and boyd lindholm
yu vs mann tailors bunion
both are 5th shaft medial oblique wedges to correct lateral IM angle yu-distal mann- proximal
use? Graston vs ASTYM which one is less painful? why?
both are instrument-assisted soft tissue mobiliziation Graston: breaks up scar tissue adhesions ASTYM: promtes scar tissue resorbtion (less painful)
Chronic Bronchitis vs/same Empysema
both are obstructive lung disease and both have decreased FEV1/FVC ratio -Productive cough for >3 months for <2 years vs -Exhlation through pursed lips to increase airway pressure and prevent airway collaps during respiration
Indium-111 use vs Gallium
both bind WBC Indium: acute infection vs Gallium: subacute and chronic infections
FEV1/FVC ratio for COPD vs Restrictive lung disease
both decreased. noral is 80%.
the sural artery (inferior muscular) supplies blood to (4)
both heads of gastrocs plantaris soleus
difference between short wave and microwave Diathermy
both heat tissues shortwave uses high frequency electromagnetic microwave use radiation
Fillauer Bar vs Dennis Brown bar
both treat same thing: -Metatarsus adductus -vertial talus -club foot originally difference: fillaure clamps to soles of pt feet while the dennis brown bar the shoe is attached to the bar
what defines sinus bracycardia vs tachycardia
brady <60 bpm tachy >100 bpm
Echogenic ultrasound
bright white image very dense object: bone US wave bounces back off bone
treatment for necrotizing fascitis (3)
broad spec abx Carbapenem or Beta lactam MRSA drug
Brodies abcess is often misdiagnosed as ostoid osteoma why?
brodies abcess a form of sub acute OM can be dormant for many years in which radiographically it takes the form of a radiolucent cavity surrounded by denes sclerotic bone and fibrous tissue
traumatic syndactyly most often occurs from
burns W441
plate used to protect from compression or axial loadig
butress pate
plate: protects bone that is unstable, and protects from compression or axial loading such as comminuted fractures or bone grafts. prevents shifts
buttressing plate
cadence vs speed
cadence= step/time speed= distance/time
which ossifiys first: talus or calcenus
calc
treatment of painful nerve endings include
capping the nerve silicone shielding covering nerve with muscle or vein placement of cut nerve into muscle belly or bone
safe bet closure suture
capsular closure (2-0 or 3-0 Vicryl) subcutaneous tissue (3-0 or 4-0 Vicryl) Skin (4-0 Nylon or Prolene)
purose for surgical instruments materials carbon chromium tungston carbide needle driver
carbon: hardness chromium: oxide layer protection tungston: extreme harness needle driver
Observational study where case (diseased) and control (non-diseased) are identified. ussualy a retrospective study where reserches look back in time to investigate disease or exposure, to evaluated risk factors
case control study (odds ratio is determined in both case control and cohort)
cat bite, dog bite, organism, tx
cat bite: pasteurella dog bite: strep viridans, Canimorus
long term non stochastic effects of radation
cataracts organ atrophy reduced fertility sterility
name the phsophate injectibles
celestone dexamethasone
which injectible is both acetate and phospate
celestone soluspsan (betamethasone)
make up of keflex
cephalexin
how can potential jurors be challanged
challanged for cuase or peremtorily
what causes joint pain in the winter
change in barometric pressure that changes joint synovial pressure causes pain
strain:
change in length divided by original lenght of given tissue due to stress applied
licked candy stick appearance describes what radiographic pathology
charco
indications for Intramedullary nail (5) positioning of the foot? too much reaming can cause?
charco arthropathy End stage PTTD Failed ankle implant Talar AVN postraumatic arthritis plantigrade, 0-5 valgus (same as in triple arthrodesis), 10-15 external rotation of foot osteocutaneous necrosis W363
why would WBC-labeled bone scan be helpful in distinguishing Charco from OM
charco is not an infected pathology
Diagnostic test for cystic fibrosis
chloride sweat test
Metformin and what other 2 DM drugs should be held preop
chloropramide and secretagogues
Located in talus or calcaneus Pain, swelling and tenderness Well defined, oval osteolytic lesion, eccentrically or centrally located Hemorrhagic foci, cystic blood spaces
chondroblastoma
Tumors composed of hyline cartilage
chondroma
scalloped margins indicate which bone tumor, well circumscibed,
chondromyxiod fibroma
brodies abcess aka
chornic OM or a form of sub acute OM which can be dormant for many years
Addisons disease
chronic disease of deficiency of aldosterone and cortisol production due to loss of gland function (opposite to cushing syndrome)
lawson's classification
classifys navicular ossicles
triad for Thromboangitis obliterans
claudication raynauds superfical thrombophlebitis
Antibiotic that is effected at penetrating the glycocalys around prosthetic imlants and is an effective alternative to cefzolin as a OR bacterial prophylaxis
clindamycin 600mg IV
Diagnosis for Muscular dysrophy (4)
clinical EMG muscle biopsy elevated CPK
if a pt with PAD cannot take asprin 81mg (first line of treatment), what is an alterantive anticoagulant
clopidegrel
when in podiatry are CAT scans used (3)? higher or lower radiation than MRI?
coalitions, complex fractures, charco foot higher radiation than MRI
when using contrast baths for muscle fatigue, edema, and RSD always start and stop with which bath
cold
Marfan sydrome
collegen defect makes people tall and slender. arachnodactyly, hyperextensibility, muscle mytonia, joint dislocation, sever pes planus, scolioss, lens subluxation, genu recurvatum, aorric dilation and aneurysm
draw out the sciatic nerve branches
common peroneal gives off deep peroneal and superficial peroneal the other side of common peroneal turns into LSC-->CRof LSC that joins with MSC which had branched from Tibial nerve
Diagnostic block for peroneal spasm?
common peroneal nerve
Nerve root for: common peroneal? Sciatic/Tibial? Femoral?
common peroneal: L4, L5, S1, S2 Sciatic/Tibial? L4,L5, S1,S2,S3 Femoral? L4, L3, L2 Draw the T12--> S4 chart from lower
purpose of cluffy wedge
commonly used in hallux limitus: holds hallux DF to promote resupination in flexible flat foot (mimics jacks test)
communicating vs perforating viens
communicating: superfical to superficial periforatiing: superfical to deep or vise versa
McGill pain index
compairs different diseases togeter like RSD/ CRPS is rated higher than chronic back pain
stress radiograph anterior drawer when compared to contralateral ankle
compare ATFL integrety to contralateral, >3mm is significant
what does RCSP represent
compensated at STJ
what is the first document filed in court for malpractice
complaint
atelectasis
complete or partial collapse of the entire lung or area (lobe) of the lung, most common issue with breathing after surgery
what is a stump neuroma
complication of neurectomy of mortons neuroma when the nerve tries to regenderate and forms bulb shaped stump, requireing same surgical treatment
what should occur before callus distraction of 1mm perday takes place
compress site for 7 days W366
Peroneus brevis vs longs on MRI? What is the main cause of this muscles longitudianl tendon tear?
compression by the peroneus longus on the peroneus brevis at the fibular ridge
plate: a plate with screw holes with sloped edges on the sie of the hole distal and from the fracture site. indicated when there is room for a lag screw
compression plate
plate in which the screw holes have sloped edges on the side of the hole distal from the fracture site
compression plate (prefer compression plate on transverse fx of 5th met shaft vs an intrameduarly screw if fx were a jones fracture.)
VTE prophylaxis for an active bleeding pt post op (4)
compression socks intermitant pneumatic compression devices venous foot pumps inferior vena cava filters
Russianing used in Exfix has what purpose
compression. the wire has a bow init
describe a kolionychia toenail
concave spoon
Clinodactyly
congenital curly toe
which calc fragment is the fragment to which all other fragments are fixed to, located at the sustentaculum tali which is the superiormeidal fragment
constant fragment
SE for opiods (4) most serious ?
constipation, urinary retention, nausea most seriorus: respiratory depression
Name the three parts that make up stance phase and %s
contact (27%) midstance (40%) propulsive (33%)
frankly infected aka
contaminated
when is an open fracture considered contaminated vs infected?
contaminated: treatment received within 6-8 hrs infected: treatment rceived >6-8 hrs injury
CT: Window width= contrast, smaller width, higher contrast Window level = density. CT number below window ______. CT number above window _____
contrast, smaller width, higher contrast density. CT number below window, black, white
ASA class III examples (8)
controlled CHF uncontrolled HTN uncontrolled DM History of MI, CVA, TIA COPD Stable Angina regular scheduled dialysis chronic renal failure
injury term: hip pointer
contusion of iliac crest
what method is being described? whirlpool or hydrotherapy
convection
Observational, where a cohort (subject spent time together) of exposed and non-exposed subjects are followed to see if dx develops. Usually prospective. calculates an odds ratio. calculates incidence, risk factors and prognosis
corhort studyd and case control
evans calcenal osteotomy
corrects flat foot in transverse plane
define passivation
corrosion *resistance* with oxide that is impervious to water and gas
tighter pitch designed for_____ screws higher pitch designed for ______ screws
cortical cancellous
General: cushing sydrome
cortisol increase
Laboratory tests prothrombin time measures how long it takes for blood to clot. _________ affects the physiological factors that prothrombin time measures.
coumadin
-creep definition? -metallosis definition?
creep: increase in strain when skin is in constant stress. occurs in minutes due to extrusion of fluid from dermis and a breakdown of dermal framework metallosis: *release of corrosion* debri and flaking into surrounding tissue
early sign of avn on xray
crescent sig: a subchondral fracture thorugh the insertion of the individual trabeculae
crystals within synovial fluid=
crystal-induced synovitis
whip maneuver
cuboid subluxation
Niacin SE
cutaneous flushing
eponychium
cuticle
what does bone marrow look like on T1 and T2 images
dark if normal is light, light if normal is dark
if an xray is over exposed it is
darker
how does acidity affect an anesthetic block
deactivates it
sequestrum
dead bone "S for Sick bone"
function of TP at contact (3)
decelerate STJ decelerate anterior tibia movement decelerate interal rotatio of tibia
decerebrate vs decorticate? what stage glasgow for each?
decerbrate (extension to pain Glasgow motor 2) deorticate (flexion to pain Glasgow motor 3)
Vitamin K does what to INR?
decrease (decreases the time to clot blood=clot quicker)
Digoxin chronotropic effect
decrease HR
stress relaxation
decrease in stress when skin is held in tension at a constant strain for a given time
what to do to kvp and mAs to increase contrast
decrease kvp increase mAs
club foot xray? Talo calcaneal angle calcaneal inclination talar/neck relative to body adduction plantarflexion
decreased Talo calcaneal angle decreased calcaneal inclination increaed talar/neck relative to body Increased adduction increased plantarflexion
why is Metformin held 24-48 hours before surgery
decreased renal function perioperatively cuases build up of metformin--> lactic acidosis metformin (-) lactic acid ability to enter gluconeogenic pathways in liver metformin (-) gluconeogenesis
Femoral neck version birth to adult aka femoral torsion, angle of antetorsion, angle of declincation
decreases: birth 30-40 adult 8-14
what is difficult to avoid cutting with a 1st metcunieform disection
deep perforating artery
When performing a Lapidus procedure for hallux abductovalgus, what structure should be avoided when exposing the first metatarsocuneiform articulation?
deep perforating artery.
Ehlers-Danlos syndrome
defects in collagen synthesis and structure; hyperelasticity
Plastic deformation
deformity exceeds the elasticity of the bone to recover so it cannot go back to normal bone shape due the damage to the cortex
False Claims Act:
defraud governmental programs, claim a doctor did a procedure without really doing it.
Increased chem lab indicates
dehydration
the process of falling out of sinc in MRI is called
dephasing
Breslow cancer stanging
depth in mm and % 10 year survival rate. <1mm 95-100% survival rate 1-2mm 80-96% survival rate 2-4mm 60-75 survival rate >4mm 50% survical rate
Herpes zoster which dermatome
dermatome: T7 (thoracic and trunk)
onychomycosis is most commonly infected by what
dermatophytes
where part of the bone does salmonella infect first
diaphysis
Wht are the Diastolic (5) vs systoilic murmurs ?
diastolic: "ARMS PRTS is PDA" Aortic Regurge, Pulmonary Regurge Mitral Stenosis, Tricuspid Stenosis also, PDA for systolic: flip the A with M, and P with T Mitral regurge, Tricuspid Regurge Aortic Stenosis, Pulmonary Stenosis, also MVP and VSD "the MVP has VSD" https://www.youtube.com/watch?v=sL0vHiXLZ-4 FA 279
how to give both Td and TIG at same time
different arms to avoid reaction
Brostrom-Gould
dir repair of ATFL with inferior extensor retinaculum reinforcement
use for Digoxin (3)
direct parasympathomimetic effects to treat: -atrial fibrillation -flutter, -certain arrythmias such as torsades
direct vs indirect reduction?
direct: open it up indirect: keep it closed
what is dissociative anetheisa what drug causes it
dissociative anetheisa (eyes remain open with slow nystamic gaze ketamine
Major SE for Ketamine (4)
dissociative anetheisa (eyes remain open with slow nystamic gaze unpleasand hallucinations fear and confusion cardiovascualar stimulation (arrythmias) SP204
joints affected in arthritis: distal IPJ vs MTPJ
distal IPJ: OA vs MTPJ: RA
which part of the femur is the last to fuse
distal femur (18-20 yrs)
-When doing a 5th derotational arthroplasty, the elliptical incision should be: - the more oblique= - the more longitudinal=
distal medial----> proximal lateral oblique=more transverse plane correction longitudinal= more frontal plane correction
most common location of heel pain in RA pts
distal plantar fascia
What would a dorsoplantar radiograph of the foot with a plantarflexed first ray taken in the angle and base of gait show the position of the hallucal sesamoids to be?
distal to the metatarsal head.
For the traditional Austin procedure to be modified to produce both shortening and plantarflexion of the capital fragment, how must the osteotomy be angulated?
distal-medial dorsal and proximal-lateral plantar.
derotational skin plasty for 5th digit
distal-medial to proximal lateral
what is the screw shank? what type of screw is the shank only found
distance between the head and the first thread. *Cancellous screws*
define stride lenght? average stride length?
distance between two consecuative contacts of same foot. (heel contact of one foot to heel contact of same foot) average stride length 4.5 feet
general class of medication to avoid with gout
diuretics (increase osmolarity)
what not to do when sending gouty tophi to the lab
do not send in formalin, it will dissolve the gouty tophi
Advantage of Crescentic bunionectomy
doesnt shorten metatarsal while correcting IM
The 2nd plantar interosseous deep/dorsal to the DTIL?
dorsal Interossiu (dorsal, 4th layer) DTML lumbrical (plantar, 2nd layer)
How many tarsometatarsal ligaments are there: dorsal? plantar? interossie?
dorsal: 8 plantar: 9 (8 + 1st cun to 3rd met) interossie: 3 (including liz franc)
Ankle joint motion in closed kinetic chain : forward motion? vs backward motion?
dorsflexion and abdut=appears inter rot of leg vs platnarflexion and adduct=appears ex rot of leg
positive babinski sign
dorsiflexion of the big toe and fanning of all toes
A patient presents with an acute dorsal dislocation of the third metatarsophalangeal articulation. Radiographs show no fractures and closed reduction is performed under local anesthetic. What is the proper sequence of maneuvers to reduce the dislocated digit?
dorsiflexion, longitudinal traction, and plantarflexion of the digit.
surgical correction for a coleman block test that results in the hindfoot becoming more rectus due the 1st ray becoming plantarflexed
dorsiflexory wedge osteotomy of the 1st met
causes for polydactly (4) most common vs least common
down syndrome lawrence-Moon-Biedl syndrome chondroectrodermal dysplasia trisomies 13,18 FH post axial most common central least common
post op for skin graft (4)
dressing remains 5-7 days, (2 days if meshing) elevate limb aspirate any fluid under graft eliminate shearing
Tibialis posterior tendon trasfer indication (2)
drop foot, recurrent club foot
Alginate use
drys out wounds (highly absorbant)
what does DEXA stand for
dual-energy x-ray absorptiometry
Turk test
dx tarsal tunnel sydrome caused by varicosities: test is positive with an inflatted tournaqeut and symtoms increase
Vinnete describing an older gentlement with the following will most likley have what? Dislocation of the joint. Heat. Insensitivity in the foot. Instability of the joint. Redness. Strong pulse. Swelling of the foot and ankle (caused by synovial fluid that leaks out of the joint capsule) Subluxation (misalignment of the bones that form a joint)
early signs for charco
why is marcain CI in childeren <12
effects growth plates
describe the primary lesion: plaque
elevated lesion >1cm
treatment for dermis statis ulcers (3)
elevation, diuretics, compression stocking.
CI for therapeutic ultrasound
embolic areas anesthitized skin epiphyseal area in kids bony prom DVT acute infection around metal implants pts with pacemakers
A 31-year-old female presents with a complaint of pain of the dorsal distal aspect of the hallux. Radiographs reveal a radiolucent area at the distal phalanx with surrounding sclerosis. There is no sign of infection, no sinus tract, and no edema. What is the clinical diagnosis?
enchondroma commonly found in proximal phalanx
Benign bone forming lesion, its technically a hamartoma (normal tissue in an abnormal loation) (bone island)
enostosis
santyl or other topicals that degrade eschar, protein and other nucleic agentes, which are reffered to as colagenase is what kind of debridement
enzymatic
Hemmoragic blister skin layer location
epidermal- dermal juntion
Avoid THIS DRUG in pts receiving Halothane, as it sensitizes the myocardium in the presences of exogenously administered doses.
epinephrine or any vasoconstrictors
Avoid compression across the _____ or _____ because it could create additional damage.
epipysis or physis
What is erysipelas vs cellulitis
erysipelas: actue *superfical* form of celluitis involving the dermal lymphatics. sharply demarcated, more of a systemic symtoms: fever and chills Cellulitis: deeper penetration into dermis and subq
Erythema nodosum vs erythema multiforme
erythema macles on shins, no central clearing, painful due to delayed hypersensitivity (type 4). is self limiting vs hands and feet, puritic, blanches*
oral tx for erythrasma
erythromycin or tetracycline W242
ester vs amide which has a higher allergy
ester
which IV anesthetic for induction doesnt have anlagesic properties and is useful in pt with comprimised myocardial contractility
etomidate (vs propofol which has SE of hypotension)
idiopathic thrombocytopenia skin? INR? Platelet? PTT?
excessive brusing and bleeding with normal inr, normal platelets, normal ptt?
symtoms of aortic stenosis? (3)
exertional angina exertional dysnea syncope.
difference betwen an expert and non expert whitness
expert: an give opinion non expert: only facts
sniffing when reffering intubation means?
extend the head and flex the neck. best postion for laryngoscope
shoe flange
extra stability on outside of shoe (medial for pronation and lateral for supination gait)
Deltoid ligament of the ankle is extrinsic or intrinsic
extrinsic just like the CFL
embryology reason for syndactly?
faiure of ectodermal ridge to stimulate the neccessary cell necrosis that leads to formation of interdigital clefts
T:F Osteoblastoma pain is relieved by aspirin
false
true or false: Partially threaded screws require an overdrill
false
T:F bicarb lab gives additional inforation on lung and/or breathing
false (assess Kidney function)
T:F a completley healed wound after an injury has skin tensile strenght of normal skin?
false (reaches 70-80% of normal skin)
T:F Hypermobility of 1st ray increases ROM
false is a mobility that shouldnt be there
T:F skin grafts can be placed directly over cortical bone or tendon
false (Recipeint site requires a vascular site)
T:F Parents can provide infomred consent for thier minor children
false: parents can provide informed permission
Neurfibromatosis (von recklinghausen dz)
familial condition affecting nervous system, muscles, bones and skin
fast or slow film/scree is safer for pt xray
fast
short term non stochastic effects of radiation (5)
fatique and skin changes nausea, bloody vomiting and diarrhea
DM ulcer smell: fecal vs Fruity
fecal- anaerobes vs Fruity-pseudomonas
what is medicaid
federal state program for poor, blind, disabled (medically needy)
fentyl vs morphine which is more potent
fentanyl is 100x more potent that morphine
Fibrous tissue develops in place of normal bone Pain, deformities, fx and nerve entrapment Scar like tissue
fibrous dysplasia
Ground glass appearance on X-ray
fibrous dysplasia causes bone swelling and expansion
bosworth fracture
fibular fx medial posterior
Eburnation def? seen in which arthritis?
final end bone product of sclerosis seen in OA
Gordon Sign? postive sign indicates?
firmly squeeze calf muscles results in extension of great toe (postive sign=UMN lesion)
What angle is a weil done at?
first cut: at least 30 degrees second cut: parallel to the WB surface
Degree of frostbite: -skin is pale initialy -but becomes erythematous and edematous with thaw -no blister or vesicle formation
first degree
-majority of PMMA beads leak Abx in what amount of time? -when should they be removed? -Studies have shown leakage upto ___years post application
first few hours to days -removed 2-4 weeks later, or else after all the Abx have leaked out, the bead becomes a source of bacteria up to 5 years
double hump curve, where is TP vs TN, best hump for sensitivity vs specificity
first hump: TN and sensitivity second hump: TP and specificity
Which radiographic finding is most important in evaluating placement of an osteotomy for correction of hallux valgus?
first intermetatarsal angle.
stage of CPRS: pain, burning and swelling for 1-3 months
first stage: inflammatory or acute
difference between flare and flange on shoe
flare increases width of shoe flange stabilizes side of shoe
describe the primary lesion: patch
flat >1cm non fluid filled lesion
negative Hubscher Maneuver test
flat foot is rigid
If the after the coleman block test the 1st metatarsal plantarflexes and the rearfoot becomes more rectus
flexible rearfoot varus
Indications for STATT? (3)
flexible rearfoot varus too much supination dorsiflexory weakness
Gigli saw
flexible wire saw
Which of the three theories describes this type of hammertoe? TAL was done->achilles does not have enough plantarflexion->FDL over fires and over powers intrinsics. hypermobility occurs
flexor stabilization
porta pedis floor and roof
floor: AbH roof: QP
determining skin flap viability?
fluorescein dye study. It is an accurate predictor even at 18 hours post injury
main goal for midstance? how is midstance defined
foot to become rigid lever. opposite side toe off to heel lift of support foot
stress
force applied over a crossectional area "streSS croSSesctional"
Nutcracker sign vs Nutcracker syndrome
forced plantarflexion at AJ elicits pain for shepherd's fx vs Navicular fractures 1: Tuberosity fx: PT tendon avulsion-nutcracker syndrome *2: Dorsal lip fx: most common* 3a: Nondisplaced body fx, 3b: Displaced body fx. 4: stress fx. intraarticular,
fully compensated equinus gait (4)
forefoot supinatus STJ pronation Heel valgus HAV deformity (most pathologic)
degree of frostbite: -full thickness -gangrene tissues -need to wait for demarcation of gangrene before amputation
fourth degree
neurolysis
freeing a nerve from adhesions
Key Crego Mcglammary Langenbeck Freer Sayre
freer elevators
DKA symtoms (8)
frequent urination. extreme thirst. high blood sugar levels. high levels of ketones in the urine. nausea or vomiting. abdominal pain. confusion. fruity-smelling breath
blunt tip needle used for
friable tissues like kidney and liver
-disease of spinal cord and Periperhal nerve degenration. -pts develope soliois and need back surger -awkward unstead gait -doesnt affect cognitive function -affects heart to pump at capacity -symtoms occur between 5-15 years old -pts are confined to a wheelchair 10-20 years after onset
friedriech ataxia
where is the Vamp on a shoe
front 1/2 of upper
Plantar fibroma ultrasound
fuisform shaped, heterogenous, hypoecjoic (dark) mass next to plantar fascia
NCSP 6, RCSP 0 =
fully compensated
orthotic type that posting is used only
functional
difference between functional and accomodative orthotics?
functional: foot takes shape of orthotic accomodative: orthoic takes shape of foot
most common pathogenic fungi affecting human is
fungi imperfecti
Patient with shortness of breath. 4 plus pitting edema. What would be most helpful in treating his SOB?
furosimide
Infected hair follicle
furuncle aka boil (Carbuncle is multiple furuncles) "multiple cars" staph a
what are the stance phase muslces (4) vs swing phase muscles
gastroc soleus FHL FDL TP? anterior tibialis EHL EDL PT,PL,PB all intrinsic
TAL vs Recession for positive silverskoid with knee flexed and extended
gastroc recession
Tendon healing process 4 weeks worth
general inflammation week 1: severed ends fill with granuation tissue week 2-3: increases paratenon vascularity, collagen fibril alignment week4: return to full activity w/o immobilization
what is atrophie blanche
generally occurs after chronic statis dermatitis and or statis uleration, presents with white plaques of sclerosis, hyperpigmentation
atopy
genetic tendency to develop an allergic disease such as asthma.
Person with increased plantar heel pad thickness,
giantism
A 43-year-old male with Addison's disease of 20 years duration is on a maintenance dose of 30 mg. hydrocortisone per day. Prior to surgery, how should this patient be treated?
give a stress dose of glucocorticoids (100 mg hydrocortisone phosphate IV q 24 hr)
Trendelenburg muscle weakness? innervation?
gluteus medius (inervated by superior gluteal n)
cause of equinus in DMII
glycosilation of collagen in achillis tendon cuases it to become tight (glucose is trapped and causes the tightness). tight achilles causes lack of dorsiflexion in gait causing exccess plantar pressures
grades of sprain and treatment (3)
grade 1: rest, protect, reduce swelling, grade 2: restore ROM, strenght, flexibility grade 3: avoid twist, turn, sudden or sharp turns. gradual return to play. Surgical repair= rare (indicated with continued pain)
what entity is issuded an inditctment? is the accusted present?
grand jury and the accused is absent
When is open reduction is recommended for Lisfranc injuries?
greater than 2 mm.
MRI of muscle belly axial
grey
Erysipelas micro bug
group A strep (strep pyogenes) "red mitten on baker #1 demonstrates well demarcated border red lesions
Drato, Oloff and Jacob Classification (4 stages)
hallux limitus: stage 1: functional stage 2: stuctural adaptation pain stage 3: joint destruction stage 4: ankylosis
coughlin and shernas classification?
halux rigidus. *grade 0*: 40-60 degrees DF, normal xray, no pain. *grade 1:* 30-40 degrees DF, dorsal osteophyes, mild pain. *grade 2* 10-30 degrees DF, narrowed joint space, more pain. *grade 3* <10 degrees DF, constant pain end ROM. *grade 4* < 10 degrees DF, pain mid ROM
hammer toe vs claw toe vs mallet toe
hammer toe: DF MPJ, PF PIPJ, Ex DIPJ claw: DF MPJ, PF PIPJ and DIPJ mallet toe: PF DIPJ
scleroderma
hardening of the skin
Hubscher Maneuver tests
have the pt stand WB, grastp the hallux and passibly dorsiflext it if this creats an arch then the flat foot is *flexible* (This is a positive Test)
Herbert screw
headless, 2 threaded sections separate by a smooth section, can be used across articular surface-OCD repair
insertion for flexor hallucis brevis
heads unite and insert base of proximal hallux
what is congestive heart failure
heart is unable to pump sufficiently to maintain blood flow to meet the body's needs symtoms include: shortness of breath, excessive tiredness, and leg swelling.
best way to test the heart?
heart stress test
axial sesamoid foot position
heel raised on horizontal plate
Multistick needle catheterization
helps rule in/out compartment syndrome
xanthrochromia association
hemmoragic synovial fluid
what can cause a false elevation when determining hyperkalemia
hemolysis
Muffucci's disease
hereditary multple endochondromaatosis with ST telangiectases (100% malignant)
pizeogenic papules
herniations of the fat pad into the dermis
best combo for ideal xray: kvp: mAs: exposure time
high kVp low mA short exposure time
does bupivicane, tertacaine, and procaine have a high or low pkA
high=slower onset (8.1-8.6 pKa)
Talipes Calcaneovalgus
hindfoot eversion and dorsiflexion
Popliteal block location
hits the sciatic nerve (posterior knee about 7cm proximal and 1 cm lateral to transverse popliteal crease) need to also inject at the saphenous n
Stent dressing use
holds skin graft in place
Thiazide SE
hyperGLUC" Hyper-glycemia, Hyperlipidemia (cholesterolemia), Hyperuricemia, Hypercalcemia Sulfa Hypokalemic metabolic alkalosis
mortons neuroma on ultrasound
hyperchoic due to its density. (AMPLE practice questions)
wooden objects on ultrasound
hyperchoic with a hypoechoic dark shadow
cholesterol is increased in what pathologies (5)
hypercholesteremia biliary obstruction hypothyroidism enphrosis DM W326
normal tendon on ultrasound
hyperechoic
Ehlers-Danlos syndrome clinical exam (3/5)
hyperelasticicty, flat feet, genu valgus, congenital hip dislocation, scoliosis
affects of Steroids (6)
hyperglycemia Anti Inflammatory Immune supression Decrease collage formation (tendon rupture) Decrease bone formation (osteoporosis) Decrease granulation (keloid break down)
what general diagnosis can cause the following? Polydypsia, polyuria, weakness, lethargy, organ calcification, kidney stone, ostoclastic giant cell. Brown tumor (bone cyst). Subperiosteal bone resorption!, acroosteolysis. Chondrocalcinosis. Increase alkaline phosphatase
hyperparathyroidism
a scar that results in unchecked proliferation of the fibrous tissue following an injury to the skin and remains confined to the site of the original site of injury
hypertrophic scar pic vs (keloid scar that invades surrounding tissue, has increased histamine, well demarkated)
Tendinosis and tendon tears ultrasound
hypoechic (dark)
SE for sulfonylureas (2)
hypoglycemia, weight gain
SE of furosimide (5)
hypokalemia exacerbate HF interstitial nephritis hyperurecemia contraction alkalosis
3 main causes for osborn waves aka J-wave on EKG?
hypothermia, hypercalcemia, MI
General: Subacute *thyroiditis*
hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel *thyroiditis* -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens
General: Riedel thyroidisits
hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens
General: Hashimoto thyroditis
hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens
General: Cretinsim
hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens
General: Wolf-Chaikoff effect
hypothyroidism Hypo: decreased T3/T4, increased TSH "RICH DaWG" -Reidel thyroiditis -Iodine def -Cretinsim =congenital hypothyroidism -Hashimoto thyroiditis (most common) -De Quervain =subacute thyroiditis -Wolf-Chaikoff effect -Goitrogens
TSH >10 indicates? increased serum creatine kinase is associated with hypo vs hyper?
hypothyroidism hypothyroidism
what are the levels of evidence from I-6 what is the higest level of eveidence? which is higher case control or case series?
i META SYSter, RANDOM CO/CASE. 1. meta analysis 2. systemic review 3. randomized controlled trials 4. cohort and case control studies 4. case series and reports 5: ideas/opinions/ editorials
quasi-contract (implied-in-law contract)
if a physician treats an victim, he or she cannot get sued if caused a harm to the victim during the process.
when would a civil malpractice case be tried in a united states district court? (2)
if citizens are from differing states and matter of question is >75,000$
when will a mal practice be presented in front of a jury
if either party demands it
when is a doctor liable for "bad results" on a case?
if he promised or guarenteed a result that was not achieved
When a hospital denies staff privileges to a doctor, what are the doctor's legal rights?
impartial hearing which is reviewable by the court
purpose for kirby's skive
improve supination by creating a varus wedge
positively vs negativley skewed data graphs
in skwed graphs, the more reliable data point is the median rather than mean. positively skewed: right squewed- mean > median negatively skewed: left squewed- mean < median
preferred method of treatment of burns inpatint vs outpatient
in-pt: open= topicals applied w/out dressings out-pt: closed=topicals applied w dressings
positive stemmer sign
inability to pinch the dorsal aspect of the skin between 1st and 2nd digits (may be cuased by lymphadema). *positive sign is inability*
where does MPn run in foot
inbetween FDB and AbH
Warfarin does what to INR
increase (increased INR=increased time to clot)
what to do to kvp and mAs to: increase density
increase both
how to change mAs with dry fiberglass
increase by 40%
how to change mAs with wet fiberglass
increase by 60%
Digoxin ionotropic effect
increase contractility
purose of a shoe flare
increase width of shoe for instability
pheochromocytoma? symptoms?
increased catecholamines due to catecholamine secreting tumor (chromaffin cells) in adrenal medulla. symtoms: HA, sweating, tachycardia
Neurovascular theory: charco
increased peripheral blood flow from autonmic neuropathy leads to bone resorption
why avoid tourniquet with sickle cell pts (3)
increased risk of local acidosis hypoxia venous stasis
excess thermal energy from a bone saw or drill can cause damage to bone how
increased zone of resorption at the osteotomy site
calcaneocuboid angle is changed how in skewfoot? hallmark?
increased. hallmark is lateral subluxation of navicular on the talar head.
parathyroid hormone function
increases blood calcium
Hydrogels use
indciated for dry wounds to rehydrate them
common complications for ankle arthroscopy (5)
infection nerve injury vascular complications reflex sympathetic dystrophy synovial fistulas
for heat therapy t be beneficial what phase of healing needs to be done with
inflammation phase
most common loccation for aortic, femoral and popliteal aneurysm
infrarenal aorta
Gabapentin MOA
inhibits: AA and GABA (gamma aminobutyric acid)
what causes calcaneal apopysitis (sever's disease)? -recall the secondary center of ossification post calc? -age of kid/gold standard for treatment?
innflammation of the seconary center of ossification center of calcaneus (4-10yr) due to traction apopysitis and repetative microtrauma seen in children. 8-14 years old is average age of occurance. / gold standard for treatment is short leg cast immobilization for 2-4 weeks (BV) or orthotics (AMPLE)
difference between medical malpractice being civil or criminal
intent
lateral talocalcaneal angle? increased or decreased with flatfoot?
intersection of the line bisecting the talus with the line along the axis of the calcaneus on lateral weight-bearing views. *>45 degrees =hindfoot valgus, component of pes planus*
what is the relationship between: mAs vs kVp
inverse mAs: quantity of x-ray emitance "A for dArkness Amount, Quantity" how dark the scales are. kVp: controls contrast or grey scale (quality) "V for Visualize the grey, contrast for better quality" W198
mech of injur for anterior process of calc? most common cause of this injury
inversion and plantarflexion. wearing heels
Sinus Tarsi syndrome occurs most often when
inversion sprain
medial calcaneal osteotomy for flat foot surgery affects the achilles how
inverter of subtalar joint
Involucrum
invo*l*ucrom: new/living bone growth around a sequestrum "L for living bone"
animal bite, irrigate with
irrigate with 1% benzalkonium chloride
thrombocythemia.
is a disorder in which excess platelets are produced, leading to abnormal blood clotting or bleeding.
Young's modulus
is a measure of the ability of a material to withstand changes in length when under lengthwise tension or compression. Sometimes referred to as the modulus of elasticity, Young's modulus is equal to the longitudinal stress divided by the strain.
polycythemia vera.
is a slow-growing blood cancer in which your bone marrow makes too many red blood cells.
verrucous carcinoma.
is an uncommon variant of squamous cell carcinoma -seen in those who chew tobacco or use snuff orally aka "Snuff dipper's cancer." -also seen in mounth but can be on foot also
Contraction at a constant velocity at all ranges of motion by using a machine with an accommodating resistance
isokinetic
muscle contraction not associated with joint motion or change in muscles lenght. can be preformed in cast (plank)
isometric
neutrophillia is highly associated with
joint sepsis
If the radiograph is over exposed (image is too dark), what do you need to lower?
kVp and mAs
If one desires an even lighter radiograph to evaluate soft tissue, what should be done to the kVp
kVp can be decreased
treatment of choice for psorisasis (4)
keratolytics topical corticosteroids sunlight donovex (Vitamin D) W248
Reiter's disease derm finding
keratosis blennorrhagica
which provides analgesic: propofol etomidate ketamine benzodiazepine
ketamine
Prerenal azotemia is caused by
kideny hypoperfusion (w/o kidney disease) hemorrhage, shock, volume depletion, congestive heart failure, adrenal insufficiency, and narrowing of the renal artery among other things.
Heavy NSAID use not only damages stomach but can have an effect on what other organ
kidney
what organs are damaged if compartment sydrome isnt treated
kidney and nerves
organ status for hyper/hyponatremia
kidney function
specific gravity measures? normal? what pathology is it deceased in?
kidneys ability to concentrate urine normal: 1.003-1.035 decreased only in Diabetis Insipidus. Every other pathology mentioned is increased
kinematics vs kinetics
kinematic: study of motion vs kinetic: study of mass, force, momentum
most common location for septic arthrits
knee
Legg-Calvé-Perthes disease symptoms
knee (hip pathology can refer pain to a normal knee), or groin pain, exacerbated by hip or leg movement, especially internal hip rotation (with the knee flexed 90°, twisting the lower leg away from the center of the body). -reduced ROM, particularly in abduction and internal rotation, and the patient presents with a limp. Pain is usually mild
Contraindication for arthroereisis (4)
knee angular deformity tibial torsion metatarsus adductus Valgus ankle
Coxa Vara causes what more distally
knocked knees genu valgum *b*
If the radiograph is underexposed (image is washed out) what do you need to raise?
kvp and mAs
Flexor retinaculum aka
laciniate ligament
why should lacted ringers be avoided in DM pts
lactate can be converted to glucose
Which fluid contains K?
lactated ringers
Plantar fibromatosis aka
ladderhose disease, seen in plantar fasicia
Contraindications for bone stim (5)
large defect (>1cm) or >1/2 diameter) pathological fx, bone cancer, pregnancy, pacemaker.
type III lawson
largest navicular ossicle that is near talar head, may be fused
xray for an achilles tendon enthesis? what is an enthesis
lateral WB. where the tendon attaches to a bone, it can beome inflamed.
insertion for quadratus plante
lateral aspect of FDL
insertion for adductor hallucis
lateral base of proximal hallux
insertion of Abdutor digiti minimi
lateral base of proximal phalanx
What cueiform is not visible on a cavus foot on AP xray?
lateral cunieform
Tailors bunion block nerves
lateral dorsal cutaneus 4th common dorsal digital n superficial br of lateral plantar n 4th common plantar digital n
lateral flare use
lateral instability inversion sprains
Lateral ankle projection, where should the beam be aimed
lateral malleolus
best view to view os tibiale externum
lateral oblique
best radio to view CN bar
lateral oblique projection aka medial oblique view
A 21- year- old female presents with pain and swelling to the right ankle. The patient states that last week she jumped from a high fence on to uneven ground, twisted her foot and fell forward. Assuming that the foot was inverted and then forced into dorsiflexion, this type of trauma would suggest what type of frequently missed fracture?
lateral process of the talus
anterior-central portal
lateral to EHL, medial to EDL
Dermatomes of lateral, middle, medial foot
lateral: S1 middle L5 (4,3,2,1/2 of 1) medial: L4 (1/2 of 1)
Transverse banding
lead poisoning
patterns of bone destruction (3) which is least to most aggressive
least to most aggressive "alphabetical gmp" geographic moth eaten permeative
postion to put pt in when doing a right lateral ankle repair
left lateral decubitus
capsulotomie that corrects in both transverese and frontal plane (2)
lenticular Washington monument
which melanoma occurs most often on the face and is basically a malignant freckle
lentigo maligna melanoma W256
Predislocation syn
lesser MPJ instability
Wickam's striae: lace pattern white line. Flexor surface, Koebner phenomenon. Pitting nail, onycholysis, planar, polygonal, purple, pruritis Treatment?
lichen planus topical corticosteroids and intralesional corticosteroids
Lisfranc ligament anatomy? "Fleck sign" on Xray
ligament: 2nd metatarsal to 1st cuneiform Fleck sign: Avulsion of the Lisfranc ligament (at the base of the 2nd metatarsal)
difference between hallux limits and rigidus, difference between orthotic modifications
limitus: 1st MTP limitation w/o DJD (reverse Morton's extension) Rigitus: 1st MTP limitation w/DJD (Morton's Extension)
Inverted champagne bottle appearance
lipodematosclerosis
Best way to remove a skin tag
liquid nitrogen occurs more in obese, more with age
Colon CA will most likely metastasize to?
liver
Mostimportantsiteofdrugmetabolism
liver
Where are NSAIDS metabolized?
liver
amide are metabolized where? excreted where
liver kidney
Billirubin found in urine indicates damage to what organ?vsprotien
liver damage
why is spinal anestheisa not used with liver disease pts
liver disease cant make clotting factors=higher risk of spinal bleeding
most common joint affected in Charco
lizfranc
STJ neutral position puts the MTJ in ______ position?
locking
plate: plates that have screws that secure to the plate, prevending togle and providing more stable fixation, they make good bridge plates as they act like an interal external fixatior
locking plate
short wave incsion method (SWIM) is best used for
long or irregular hypertrophic scars
xray: long scale vs short scale
long scale: lots of grey short scale: very black and white
Leads on an EKG representation? where to look for an MI?: septal: posterior: anterior: lateral: inferior:
look at anterior inferior EKG. septal: V1,V2 posterior: V1, V2 anterior: V2-V5 lateral: 1, aVL, V5, V6 inferior: II,III, aVF
lower motor neuron lesions symptoms
loss of voluntary control, decreased muscle tone, flaccid muscle paralysis, muscle atrophy, absent or decreased reflexes negative babinski
upper motor neuron lesions symtoms
loss of voluntary control, increased muscle tone, muscle spasticity, no muscle atrophy, hyperactive and abnormal reflexes positive babinski (bad)=toes fan out when stroked
low plane axis= ? dominance. high lane axis= ? dominance
low plane=frontal plane dominence high plane=transverse plane dominence
does lidocaine, prilocaine, etidiocaine have a high or low pKa`
low=faster onset (7.7-7.8 pKa)
what causes erythema migrans
lymes disease
Which directly controls amount of xrays
mAs
Which is the primary control of optic density? mAs vs kVp
mAs
decrease ____ for elderly radio
mAs by 30%
primary lesion name for freckle
macule (flat <1cm)
size difference between patch, macule, plaque
macule <1cm, flat patch >1 cm, flat plaque >1cm, raised
hydrocolloid use
maintain moist wound environment while absorbing excess drainage
In using a Z-plasty to correct a skin contracture, what should the surgeon do?
make the central incision of the Z parallel to the contracted skin.
laryngeal mask airway
makes intubation easier
Russian Stimulation
makes muscles contract through full range of motion
multiple myeloma def
malignant tumor of bone marrow cells
most common malignant bone tumor most common benign bone tumor
malignant: *osteosarcoma* (Multiple) myeloma is more common but is concidered a marrow cell tumor vs a bone tumor) benign: *Osteochondroma* (pic)
Angle and Base of Gait: malleoli? foot abduction from midline?
malleoli are 5 cm apart, foot abducted ~13 degree from mid line.
ossifying fibroma is most commonly found where
mandible
vodder treatment
manual treatment for decongestive therapy of lymphangitis
met head resection with a soft tissue flap between 1st met and proximal phalanx to avoid bone on bone
many-heuter
Roentgen (R):
measurement of radiation
what kind of displacment calcaneal osteotomy to correct flat foot surgery
medial (shifting calcaneal tuber medialy)
what are the 9 compartments of the foot in danger or compartment syndrome
medial lateral superficial interossie x 4 adductor Quadratus Plantae W497
the dorsal cutaneus nerve innervates:
medial 3rd and lateral 2nd
insertion for abductor hallucis
medial base of proximal phalanx
difference between a medial buttress and medial flare modification
medial buttress: external medial flare
meuller classification
medial mal fractures A: avulsion B: transverse at ankle mortis C: Oblique D: near vertical
best view for os calcandues secondarius
medial oblique
Best view to see a CN coalition
medial oblique view
best view to view CN
medial oblique view
Isertion of Dorsal Interossei
medial or lateral side of base of proximal phalanx
Insertion of Plantar Interossei
medial side of base of proximal phalanx
Patient/ runner with tibial pain. Tibia lights up on 3rd phase of bone scan.
medial tibial stress syndrome
posterior-central portal
medial to achilles lateral to tarsal canal HIGH RISK
The relaxed skin tension lines on the sole of the foot from?
medial to lateral
The vomiting center of the brain is located in the reticular formation of the ________
medulla
wet to dry dressing or hydrotherapy is what kind of debridement
mehcanical
candel wax appearance in bone with sclerosis in the peripheray
melorheostasis
This drug can be used to control shivering in OR
meperidine (Class II drug)
what is the major soruce of vascularity to the tendon
mesotenon
Where does plantar plate rupture off of?
met head
which type of blood chemisty do you need to check the anion gap
metabolic acidosis
pH <7.35, PCo2 <40
metabolic acidosis (check anion gap)
best location to transect the shaft of met for a distraction? why (3)
metaphyseal, better vascularity and osteogenic potential, greater SA=better strenghth and stability. although its much more difficult to get to.
indiciation for youngswick modification?
metatarsus elevatus (modification to austin that shortens and platarflexes met head)
alternatice acute gout flare medication if pt already has GI ulcers and cant take indomethacin
methylprednisolon
most common IV benzodiazepines used (3)
midazolam, versed, valium
most common vessel involved in a stroke
middle cerebral artery
most common talocalcaneal coalition
middle facet
Isherwood medial Oblique Axial position
middle facet of STJ
TENS moa
mild continuous electrical current into skins which blocks pain signals and stimualtes endorphins
what circumstances can staute of limitations be extenede
minor out of state doc doctor conceals pt true condition pt didnt promptly discover ture conidtion
Period between forefoot loading and heel off
mistance 40% of stance" flexor stabilization (pronated foot and aductovarus of 4th and 5th toes)
hosystic murmur
mitral regurge
Mid-systolic click
mitral valve prolapse
Parkinson's disease: moa: symptoms:
moa: cell death in basal ganglia causing not enough dopamine to brain -Asymmetric, resting hand tremor (MC presenting feature) -Akinesia (slow movement, except in emergency) -Postural instability -Shuffling gait with lack of arm swing -Fixed facial expression -Quiet voice -Cogwheel rigidity -Myerson sign (Glabellar relex) = sustained blink response when tapping over bridge of nose -Palmomental reflex = scratching palm causes chin to tense -Dimentia in later stages NO muscle weakness Normal DTRs
which sutre has a longer 50% tensile strenght: monocryl or vicryl
monocryl: 2 weeks vicryl: 3 weeks (is at 75% strenght by 2 weeks)
Non-stochastic
more certain threshold linear safe doses of radation can be reached
what opiates are derived from the poppy plant? (4)
morphine, opium, heroin, and codeine
Talocalcaneal coalition on xray: lateral (6), AP (1) -ages 12-14,pain in sinus tarsi over middle facet decreased STJ ROM
mostly seen on lateral xray -C sign or halo sign -Absent of STJ -Talar beak sign -rounded of lateral talar process -shortening of talar neck -shortening of posterior facet -ball n socket of ankle mortis (AP)
most common cause of delayed union
motion
-6mm MPD (metarsal protrusion distance) indicates?
much longer 2nd met or short 1st. (-) indicates longer 2nd vs (+) indicates longer 1st.
Reiters - what is derm finding
mucocutaneous lesion and keratosis blennorrhagica
what is a flail chest? treatment of choice?
multi-rib fx, bruised lung can't exchange air. -Ventilator is tx of choice. pulmonary edema, tx with diuretics.
Ollier's disease
multiple endochondromas more common in children
Mosaic wart definition? what is a physcial exam finding consistent with a wart diagnosis
multiple plantar warts. side to side pinch pain (vs callus has pain with direct pressure)
Dermatomyositis
muscle weakness and skin rash
how can pts get a schedule II drug
must be prescribed by doctor, written
radiographic sings of a less agressive tumor (4)
narrow zone of transition geographic pattern no periostits sclerosing of normal bone
ultrasound near field vs far field
near field: stuctures in upper half of moniture vs far field: structures in lower half of montiure
US guided injection: how does the needle appear? how does the bolus of injection appear
needle: hyperchoic colus: hypochoic
iontophoresis, if you have *negatively* charged medication, which probe is used?
negative (cathode) The negatively charged chamber, called the cathode, will repel a negatively charged chemical into the skin.
Triple antibiotic Ointment ingrediatns (3)
neomycin sulfate, polymyxin B sulfate bacitracin zinc
Lambert-Eaton syndrome
neuromusuclar junction disease due to autoantibodis to presynaptic Ca channel--> decreaseing ACh release affecting m closer to the trunk (vs myasthenia gravis affects legs more than arms)
4 types of ulcer
neuropathic Ishcemic Decubitus Venous statis
plate designed to protect fracture sites from normal bending and rotational and axial loading plate
neutralization plate
good plate for a butterfly fracture
neutrilization plate
snow cap sign AVN
new bone over old.
is residence required to get licenced in a state
no
Does Seborrheic dermatitis cause hairloss
no they are flaky, white scales over erythematous patches, ages 20-50, in kids its called cradle cap
can you be liable at a scene of an accident?
no as long as there was no payment involved.
classical symtoms of DVT(3) and D-dimer value DVT gold standard dx?
no trauma, new onset of pain, swelling and redness in the leg with a D dimer >500 US
why wound Abx not be beneficial to PVD pt with dead bone
no vasclar to bring Abx to site
do orthotics help structual hallux limitus
no, b/c the hallux i limited when the foot is both loaded and unloaded.
which melanoma most often ulcerates and is worst prognosis and is second most common? It is often confused with a pyogenic granuloma? how to differentiate it as a vascular issue versus a melanooma?
nodular melanoma 15%. pressure for 30 seconds will collaps the vascular. W256
what is considered decongestive physiotherapy? (5)
non invasive: skin care manual lympahtic massage Exercise, PT compression bandage
Benign, metaphysis of long tubular Asymptomatic Expansive, elongated, radiolucent, multloculated lesions with cortical thinning
non ossifying fibroma
uses for an electrical bone stimulator (7)
non union, delayed union, charco, AVN, infection OM, arthropathy, acute fractures, bone graft.
Non-Stocahsic vs stochasitc sun burn will increase linearly the longer in the sun!
non-stocastic: more certain threshold linear
taper point needle used for (3)
noncutting, subcutaneus tissue, fascia
Gold standard diagnosis for CPRS
none its an exclusion diagnosis
Plantar fasciitis ultrasound normal pathological color
normal thickness is 4mm >4mm thickness, decreased echogenicity (darker)
Gissane angle
normal: *95-105* or 125-140 calcaneal fracture: increased. angle looks like a V "G for Great (increased)" *W474*
EMG
normal:unit potentials are properotioanl to effort abnorma: decreased motor units
Nodular fasciitis
notice thick collagen bundles; reactive pseudosarcoma; caused by trauma in 10-15% of cases CC: "nodules in forearm" sometimes "nodules in chest and back" "solitary, rapidly growing, sometimes painful mass" presence of extravasated red cells on biopsy associated with 17;22 translocation
open kinetic chain for MTJ
oblique axis is pronated longitudinal axis is supinated
where is the Antiglide Plate most commonly used?
oblique fracture of fibula W362
Man with episodes of blindness
occipital tumor
describe Evans calcaneal osteotomy procedure? indication?
open osteotomy of the calc 1.5cm proximal to the CCJ with insertion of bone graft -flexable pes planus W428
MTJ is in open or closed position during contact phase of gait? at contact what is the position and motion of the oblique and longitudinal axis?
open: *oblique axis:* pronated and does pronation (CC) *longitudinal axis:* is supinated and does supination. (TN)
sinus tract
opening to the outside
Gold standard for post op pain releif
opioids
case use
opposite side of injury
cutaneous larva migrans treatment (2)
oral albendazole or ivermectin
when to use oral vs topical steroids for contact dermatitis
oral with >20% skin surface affected (arms and legs)
what degree of care is required by a pod
ordinary standard of care
origin and insertion for EDB (3)
origin: sinus tarsi, Interosseous talocalcaneal lig, Inferior extensor retinaculum insertion: lateral side of EDL tenonds of digits 2,3,4 at level of base of proximal phalange and crontribute to the extensor hood.
The ossicle that may be responsible for a congenital talonavicular coalition would be
os tibialis externum
how does the role of a GRAFT affecte each of the 3: osteogenessis vs osteoinduction vs osteoconduction vs Creep substitution
osteo*g*enesis: new bone growth from cells in a *g*raft via cutting cone vs osteoi*n*duction: bone graft induces *n*onosseus tissue to become osteogenic in a favorable environment vs osteo*c*onduction: graft acts as latice and s*c*affold to allow surviving host to growth of surviving bone. hydroxyapatite vs *C*reeping Substitution: *c*utting cone of new osteo*c*lasts followed by osteoblasts which invade the grat application
Disorder of bone fragility chiefly caused by mutations in the COL1A1, and COL1A2 genes that encode type 1 procollagen. History includes Fractures after minor trauma, easy bruising, repeated fractures Hearing loss can occur in 50% with type 1, blue sclera with type 2
osteogenesis imperfecta
bone tumor to allivate pain with ASA
osteoid osteoma
pathology: Pseudofractures Looser Lines Milkmans syndrome
osteomalacia
Difference between osteoporosis and osteomalacia
osteoporosis: low amount of produced bone resorption > production (remodeling process is low) (low calcium) osteomalacia: architecturally normal with non mineralized osteoid bone (severe decreased vit D)
8 YOM fracture of tibia, most common tumor with elevated ALK? what radiographic signs give it away?
osteosarcoma (osteogentic sarcoma) -commonly found in distal femur, proximal tibia -watch out for the codman triangle (arrow), sunburst, onion skin -poor prognosis
Subungal exostosis xray
out growth that is same consistancy of bone (not radio-opaque or lucent)
ganglion cyst
outpouching herniation of joint or synovial sheath
Contraindication to diathermy (4)
over metal imlants pregnancy malignancy sensory loss
partial threaded screw omits what step in fixiation
overdrill
what steps in fixation should be the same size as the screw (2)
overdrill tap
surgery indicated for overlapping vs underlapping of 5th toe
overlapping: lapidus underlapping: thompson
Overproducer vs underexcreter or uric acid levels for gout Definition of each? which is most common? which occurs in lesch-Nyhan syndrome
overproducer: >600-800 uric acid excreted from kidney (lesch-Nyhan syndrome-treat with allopurinol) underexcreter is : <600-800 uric acid excreted from kidney more common treat with probenecid W178
what affects the ONSET of local anesthetic drug
pKa Inverse relationship smaller pKa=quicker onset smaller pka=smaller pH=quicker onset ie lidocaine, prilocaine, procaine (pKa 7.7-7.8)
common CI with therapy useing waves
pacemaker
cobra pad
pad for met head in dress shoes
Indication if a pin in an external fixator is loose or infected
pain
calcodynia
pain in heel due to fat pad atrophy
post static dyskinesia
pain with first step after rest
Myrmecia def? initial treatment of choice?
painful plantar warts. salicyclic acid
Virchow's node
palpable left supraclavicular lymph node associated with gastrointesintal neoplasm like pancreatic or gastric carcinoma
acute rheumatoid arthrits associated with
pancardidits and valvulits
loss of the anterior tibial and long extensors, and weakness of the posterior tibial, peroneal, and triceps. A flaccid pes valgus dropfoot gait is noted. What is the most appropriate method of treatment?
pantalar
primary lesion name for a acne, insect bites,warts, nevi, small melanomaflap
papule (fluid filled <1cm)
increase in eosinophil only
paracitic reaction
Incision should be made as _______ to these line as possible to minimize tension and dehiscence
parallel
shear
parallel deformation of internal surfaces of metal
normal vs coalition for middle and posterior STJ facets seen with the harris and beath
parallel-normal middle obliquly-middle facet coalition
As the STJ pronates, the two axis of the mid tarsal joint become _________=________which allows ________movement
parallel=unlocked increased
Fretting corrosion
passive layer of low oxygen is lost due to mechanical forces
what test to order with a nickle allergy
patch test
diaz-tachdijan classification
pediatric ankle fracture classification
desquamate
peel off in the form of scales.
difference between percoet and vicodin
percocet: oxycodone/acetaminophin "OP" Vicodin: hydrocodone/acetaminophin
describe gout on a xray: at least 5?
periarticular swelling joint margins errosions of joint punched out lesions complete lysis of bone Tophi (rat bite) overhaning erosions peri-articularly (martels sign) Joint space preserved
Ecchondroma aka
periosteal chondroma
creep definition in reguards to metal
permanent deformation of metal
-informed consent definition - child consent not required when -when do you have to listen to pt even if its harmful to them.
permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. child/minor (<18 years old) consent not required when life threating, may ignor partent refusal of care or religious views such as J dubs. Parents cannot withold life saving medicine from a child/minor (<18 years old). If its not a life or death emergency but serous, consult CPS for the consent. competant adult must be listened to unless pt is depressed or physc.
Rear foot varus causes increased strain on the _________tendon(s) which over time can cause a rigid deformity.
peroneal tendons
Peroneal subluxation on MRI -most common sport that cuases injury to peroneal subluxion
peroneus longus skiing
drug to reverse effects of anticholinergic in the OR
physiostigmine
calculate false positive? draw false postive positive chart? -label type I and II error - label sensitivity and specificy -label PPV and PNV -Which type error is considered underpowered in reserach
pic: a b c d false positive rate= FP / (FP + TN) false negative rate=FN / (FN + TP) Type I error=B (false positive) type II error= C (false negative) (underpowered) Sensitivity= A and C Specificy= B and D PPV= A and B PNV= C and D
coverleaf plate commonly used in
pilon fractures
External fixation pins: strenght, configuration vs wires: tensioning is different with foot vs ankle
pins: greater diameter, strongest figuaration is divergent wires: thinner but 1.5-2x stronger due to tensioning -60 (1000N) on foot -130 (1400N) on ankle
Psoriasis affects the nails how (2)
pitting salmon patches
Pharmacology: pka protein binding lipid solubility
pka: onset (inverse) protein binding: duration (direct) lipid solubility: potency (direct) "P does not go with P"
Denver Bar
placed under metatarsal bones to support transverse arch extending from the met heads to the tarsometarsal joint
In a Steindler stripping, which are stripped from periosteium of calc (5)
plantar fascia, plantar lig abductor H FDB ABDq (1st layer of plantar m)
on whom is the burden of proof in a civil malpractice
plantiff
what is burden of proof in malpractice case
plantiff must proove his case by preponderance of the evidence
what is doctrine of res ipsa loquitur
plantiffs technique to show breach of standard of care w/o direct evidence. for example forcepts found in pts abdomen
indication for talectomy
plantigrade foot
Kaposi sarcoma symtoms
plaque like
example of a load sparing implant
plate (reduces bone callous)
What is the orthoposer?
platform that enables WB images of foot and ankle to be obtained, Xray film or image receptors on the orthoposter can lei flat or be placed vertically
osteochondroma direction to joint? how common it it?
points away most common benign bone tumor!!!
Hypothyroidism symptoms? does it cause muslce weakness?
poor ability to tolerate cold, a feeling of tiredness, constipation, depression, and weight gain muscle weekness in children
circlage indication
poor bony stalk
medial inferior genicular artery supplies blood to (1)
popliteus
Trendelenburg position? Trendelenburg maneuver?
position is head lower than feet. maneuver differentiate deep and superficial venous congestion. Elevate leg to empty venous blood Place tourniquet around upper thigh ~30-60mmHg to occlude superficial flow Have patient stand
hampton's humb sign
positive for PE
Schober test
positive test for ankylosing spondylitis: negative test (normal person): a 10 cm lenghth is measured on erect spint, pt bends forward and the measurment should increase by 4cm.
in what foot type is Meary's angle positive? negative?
positive: supinated foot negative: pronated foot
pseudogout arthrocentesis lab work
positively biefringment rhomboid-shaped crystals
what does PACU stand for
post anesthesia care unit
POUR stands for
post op urinary retention
what does PONV stand for
post operative nausea and vomiting
axial sesamoid view
posterior 90,heel on platform
Isherwood lateral oblique axial position
posterior facet of STJ
direction of an achilles tear
posterior fibers are torn first so direction is: *posterior to anterior*
attachement for Inferior Tranverse lig
posterior tibia---Superior portion of malleolar fossa
What is the muscle that is most commonly transferred through the interosseous membrane to function as a dorsiflexor of the foot?
posterior tibial
Volkmann Fracture
posterior tibial malleolar fracture, seen in SER III and PER IV.
DVT leads to veins that are incompetint this is called vensou insuffisciency AKA
postphlebitic syndrome W78
what form does the antibiotic need to be in for antibiotic beads
powder
which virus is the larges virus
poxviridae W64
Basal vs prandial insulin
prandial (rapid-acting or "mealtime" insulin) -"Girls and Lads" Glusine, Aspart, Lispro Intermidiate: -"Rest Now" Regular insluin, NPH *basal (long-acting insulin)* -"Dont Go" Detemir, Glargine
lab for immediate nutrition status
pre-albumin (15-30 mg/dl) ( < = poor nutrition status)
lawn-ganong-Levine syndrome
pre-excitation syndrome of the heart due to abnormal electrical communication between the atria and the ventricles
law: define discovery
pre-trial process to obtain facts from other side including -relevant facts -documentation -evidence -preserve testimony -narrow issues -remove surprises -interogations
classification of polydactly? most/least common type?
preaxial: hallux central: digits 2-4 (least common) *postaxial: 5th digit (most common)* W440
patent had pain over 2nd MTP,swelling, some dorsal dislocation. What is thediagnosis?
predislocation syndrome
action of Tibalis Posterior at heel strike
prents STJ pronation
function of methlyparaben to anesthetics
preservative to local anesthetics to increase shelf life
function of Whitman-Roberts
prevent adduction and plantarflexion of the talus (high medial flange with a lateral clip and a cupped seat)
indication for deep heel cup
prevent overpronation
purpose for FF orthotic extension?
prevent slippage shock absorb
Marjolin ulcer develops from (3)
previous trauma chronic inflammation scarred skin
level of disease prevention: A doctor tells pt to wear a seatbelt
primary (trying to prevent yourself from getting a disease)
cause for underexcreter of uric acid gout; Primary cause? Secondary cause?
primary: kidney issue secondary: excessive acids such as lactic acid or ASA. Lead poisoning W178
p-value (significance probability) small vs large p value type 1 vs 2 error
probility that results could result in same outcome <0.05 reject null hyphothysis. >0.05= cant reject null hypothysis type 1: rejecting a true null hypothesis. type 2: fail to reject a false null hypothesis
define creeping substitution
process of cutting cone of new osteoclasts, followed by osteoblasts will invade the graft from the host bone
The direction that an xray beam travels through the body is:
projection
least reactive suture, plate
prolene (suture) stainless steel (bone fixation)
hypocalcemia EKG
prolonged QT interval
position Mid tarsal joint needs to be in when being fitted for orthotics due to plantar fascitis
pronated
The midtarsal oblique axis pronates, and the midtarsal joint longitudinal axis supinates. Is the midtarsal joint in pronation or supination?
pronates
what is a MAD axis
pronitory/supinatroy joint that moves in the direction of MAD (medial anterior dorsal)
any surgery lasting more than 120 minutes requires the use of?
prophylactic antibiotics
What is the main drug used in the OR that you avoid in pt's with an egg allergy?
propofol
onchronitic shards association
prosthetics
prealbumin is a good measure of
protein
what affects the DURATION of a local anesthestic drug
protein binding direct relationship -larger protein binding %=longer duration (bupivacine has 90%) -smaller protine binding %= shorter duration (lidocaine has 64%)
increasing pitch on a screw does what
provides larger area of contact between cancellous screw and bone (cancellous screws have a larger pitch)
course of deep peroneal nerve in proxima middle and distal tibia
proximal: between TA and EDL, middle: between TA and EHL, distal: medial to TA and lat to EDL
most common 5th met fracture
pseudo-jones fracture Type 3 Stewart
Calcium pyrophosphate dihydrate crystals build up in a joint differential
pseudogout
aspiration of rhomboid crystals
pseudogout
donovex is a treatment primarily for what
psoriasis (its a Vit D analog)
how can a pod protecti himself from a charge of battery
pt informed consent
Papineau sign
punctate bleeding seen in cortical bone indicates health bone. need to see when debriding dead bone segments so you know the resection is proximal enough and youve reached viable cortical bone
cloaca
pus filled space where sequestrum resides
how often are inpatients vitals checked
q8 hours (shift change)
is the lace stay on a shoe on the vamp or quarter
quarter
Stochasitc
random more exposure=liklyhood of occurance no threshold, non linear random mutation, CA
PCN allergy signs
rash hives (urticaria) swollen tongue wheezing cardiovascular collapse Laryngospasm
keratoderma blennorrhagica association
reactive arthritis
the coleman block test determines whether a _____________ deformity is flexible or rigid
rearfoot varus
Indiciation for tension band wiring. example?
reattachement of small fragments, too small for a screw. avulsion fracure of lateral mal
Somogyi effect
rebound hyperglycemia in AM due to glucagon/epi secretion responding to overaggressive insulin therapy the night before.
bias types (4)
recall, performance, selection, lead time
post procedure indication
rectus hammertoe (resection of head of proximal phalanx)
alpha glucosidase inhibitors moa? 2 drugs?
reduce intestinal carbohydrate absorption -acarbose -miglitol P72
on the postive: adding arch fill vs minimal arch fill
reduces arch vs creats conforming total contact othotic becuase more pressure is on the arch.
Intrinsic hemolytic anemia def
refers to a defect in the RBC causing the anemia (membrane defects, abnormal Hb, enzyme deficiency)
Westmark sign
regional area of decreased pulmonary vascularilty on CXR PE
p-value of <0.05 means?
reject null hyphothysis type 1: rejecting a true null type 2: fail to reject a false null
What is equation for radiation for workers
related to amount of mrem/year
type II lawson
remaining attached larger navicular ossicle next to navicular tuberosity
Auspitz sign
removal of silverly scales in *psoriasis* results in pinpoint bleeding
Lambrinudi arthrodesis
removes bone from distal plantar talus and displaces navicular dorsally, it correct foot equinus but leaves talus in perferred equinus position.
if adding a kirby(medial) skive onto the postive what is done? purpose?
removing small amounts of medial heel creates the varus wedging affect. to control pronation, need a deep heel cup. can skive 2,4,6 mm of positive.
Creatinine (cr) levels indicate
renal health
why cant toradol (ketorolac) be used for more than 5 days
renal toxicity
Cheyne-Stokes respiration
repeated breathing pattern characterized by fluctuation in the depth of respiration: first deeply, then shallow, then not at all until apnea occurs
fatigue fracture in metal
repetative applications of loads below yield strenght
yount (keyhole) flatfoot correction
reroute anteior tibial tendon through keyhole in navicular without detatch insertion, with poserior tibial tendon advancement under navicular
pH <7.35, PCo2>40
respiratory acidosis
under what law is a doctor responsible for his nurses negligence
respondeat superior
drug to give with infected hardware? when to leave in hardware when infected bone?
rifampin. keep in hardware if instability of bone is a risk becuase unstable bone is more prone to infection
what is used most often to irrigate in ankle arthroscopy
ringers because its less damaging to chondrocyte metabolism
Angles/position for ankle fusion: sagittal plane? valgus? externally rotated?
sagittal plane neutral *90 degrees* valgus *0-5 degrees* externally rotated *5-10 degrees*
Pagets disese radiograph stage 3
sclerotic stage, osteoblastic, thickened trabeculae, ivory appearance of bone, bone expansion
PONV drugs (5)
scopalamine Promethazine Ondansetron Corticosteroids metoclopramide
type and screen vs type and cross
screen: screen donor and recipient blood for *antibody* vs cross: mix recipient's and donor blood sample to check for *reaction*
Which of the following is commonly associated with osteoporosis
scruvy
degree of frostbite: -superficial dermis -creating blisters that will drain and form eschar
second degree
stage of CPRS: activity related pain and hypersensitivity of skin to temp and pressure. radiographs show sudeck atrophy changes for 3-6 months
second stage: dystrophic
level of disease prevention: trying to detect a disease early and prevent it from getting worse.
secondary
Berndt-Hardy classification: how to treat Berndt-Hardy lesions
see pic I,II NWB cast III,IV excision, ORIF
Hoffa sign:
seen in calc fracture where the tuber fragment displaces superiroly, relaxing the tricepts and decreasign its platarflexory power. shortening the calc lever arm.
Gower sign
seen in muscular dystropy, kids raise themselves up by first crawling
hutchinson sign melanoma
seen in subungal melanoma
semitubular plate, one third tubular plate, and one quarter tubular plate are all examples of what type of plate
self compressing plate (eccentrically sloped oval holes for screws)
are bone scans better for sensitivity or specificty
sensitivity
Specificity vs. Sensitivity
sensitivity - The probability that a test will indicate a disease among those with the disease *true positive* specificity - is the fraction of those without disease who will have a negative result: *true negative*
50,000-200,000 WBC with >90% nuetrophils vs <100,000 WBC with 50-90% neutrophils, cultures negative
septic arthritis vs inflammatory arthritis
gold standard for MA treatment in kids begin at 8 mo old
serial casting is gold standard
best view for: crista
sesamoid axial.
insertion for Flexor digitorum brevis
shaft of middle phalanx
phosphate injectable: length acting? soluable? location? color? ie?
short acting H2O soluable Injectible anywhere Clear Celestone phosphate, celestone soluspan (both), Dexamethasone (both) vs Acetate: Triamcinolon (kenalog, celeston soluspan, Dexamethasone
A 20-year-old male sustains his first ankle injury which is diagnosed as a rupture of the lateral collateral ligaments of the ankle. What is the most appropriate treatment plan?
short-leg nonweightbearing cast for eight-to-ten weeks
Wolf-parkinson-white-syndrome
shortened PR, aka bundle of kent. (Symptoms can include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope) W152
benefits of adding epinephrine to local block (3)
shortens onset of anesthesia increases duration of block vasoconstrictor
-Long bone pain, foot and hand pain, -Arthritis with a fever -AVN femoral head -chronic punched out lesions ankles -Abdominal pain with vomiting Diagnostic test to confirm? Best treatment
sickle cell anemia Hemoglobulin electrophoresis shows hemoglobin S, periperhal smear shows sickling Folic Acid
topical medications for burns (3)
silver nitrate, silver sulfadiazine, sodium mafenide W491
Homocysinuria
similar to marfan syndrome but the pts are retarted and have large amouts of homocystine in urine
define Arthroresis
sinus tarsi plug
SE of niacin (3)
skin flushing, pruritis, Rhabdomyolysis
Osteoma most common location? multiple osteomas are commonly seen in what pathology
skull Gardner syndrome (supernumerary teeth, fibrous dysplasia)
A 12-year-old male Judo patient who is overweight, limps into the office with pain in the upper thigh. The radiograph demonstrates posterior displacement of the growth plate. The appropriate diagnosis is
slipped capital femoral epiphysis.
oat cell carcinoma
small cell carcinoma: highly malignant form of lung or bronchogenic cancer in which cells appear small and rounded under a microscope
type 1 lawson
small round accessory navicular ossicle within TP tendon
small fragment screw set (2)
small: 3.5. 4.0 W359
CMT degeneration pattern? how proximal are m spared?
smaller mucles ----> larger muslce groups mucles above the knee are generaly not invloved
In a pediatric patient with a physis fracture what should you use for fixation
smooth pins
Difference between spinal and epidrual anestheisa
spinal anesthesia: *one time* injection of anesthesia. pierces the dura epidural anestheisa: *catheter placed* for ongoing anesthesia, anestheic placed into epidural space
dermatome harvesting is most commonly used with split vs full thickness grafts
split
Christman-Snook: indication?
split PB, through fib ant-post, down into calc indication: ATFL + CFL lig repair:
calcanealnavicular lig aka
spring
bowen's disease
squamous cell carcinoma in situ that resembles a localized patch of psoriasis, dermatitis or tinea (in situ means its still confined to the epidermis, considered as an early stage or intraepidermal form of squamous cell carcinoma.
action fo TP,Peroneals, intrinsic m at midstane
stability
what are oilive wires when used in Ex fix
stabilize and prevent wires from sliding back and fourth
twighlight stage of anesthesia
stage 3
National Pressure Ulcer Advisory Panel
stage I: not broken stage II: Epidermal breakdown (shollow) stage III: Dermis/sub c breakdown stage IV: mucle/bone + necrotic, + drainage unstageable: Eschar/slough entire wound W264
Guedel's stages of anesthesia: analgesia, disorentation
stages of anesthesia: *stage 1: analgesia, disorentation* stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death
Guedel's stages of anesthesia: delerium, excitment
stages of anesthesia: stage 1: analgesia, disorentation *stage 2: delerium, excitment* stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death
Guedel's stages of anesthesia: reflexes lost: eye, swallow, conjunctival
stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia *1 plane-reflexes lost: eye, swallow, conjunctival* 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death
Guedel's stages of anesthesia: loss of light relfex, dialted pupils
stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 *plane -loss of light relfex, dialted pupils* 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death
Guedel's stages of anesthesia: complete intercostal paralysis to diaphragmatic paralysis (apnea
stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern) 3 plane -loss of light relfex, dialted pupils 4 plane-*complete intercostal paralysis to diaphragmatic paralysis (apnea)* stage 4: respiratory stoppage to death
Guedel's stages of anesthesia: relfexes lost: laryngeal, corneal, tears (most nobily known for change in breathing pattern)
stages of anesthesia: stage 1: analgesia, disorentation stage 2: delerium, excitment stage 3: surgical anesthesia 1 plane-reflexes lost: eye, swallow, conjunctival 2* plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern)* 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death
which guedel stage is Surgical anesthesia?
stages of anesthesia: stage 1: analgesia, disorentation, amnesia stage 2: delerium, excitment *stage 3: surgical anesthesia* 1 plane-reflexes lost: eye, swallow, conjunctival 2 plane-relfexes lost: laryngeal, corneal. increased tears (most nobily known for change in breathing pattern), loss of eyelid reflex 3 plane -loss of light relfex, dialted pupils 4 plane-complete intercostal paralysis to diaphragmatic paralysis (apnea) stage 4: respiratory stoppage to death. overdose
how dose Periodic Acid-Schiff stain test diagnose fungus?
stains polysaccharides in cell wall-stains magenta
how does stance phase in gait change with walking vs running
stance phase with walking=60% (swing phase is 40%) stange phase with running=40% (swing phase is 60%)
clindamycin is best used for (6)
staph strep celluitis gas (closteridium perfringens) abcesses moderate to severe acne
micro that causes Furuncle Carbuncle Folliculitis
staph a (according to prometric). pseudomonas (according to watkins) Sooooo Freakin dumb
What causes cellulitis? 2 most common
staph a and Strep (most common) E-coli Klebsiella Staph epi
Ketamine uses (5)
starting and maintaining anesthesia. induces a trance-like state pain relief, chronic pain sedation, sedation in intesnive care memory loss.
diagnosis: -located just proximal to medial malleolus, erythematous scaling plaques with exudation, crusts, superficial ulcers. -pt will complain of mild pruritis, pain, edema, nocturnal cramps, and painful ulcers, may be associated with reticulated hemosiderin hyperpigmentation
stasis dermatitis W 239
a liscence to practice podiatric medicine is issued by?
state medical board
law of reciprocity
states that the 2 factors for xray denisity are Exposure time and milliamperes (mAs)
tetraology or Fallot
stenosis Intraventricular septal defect right ventricular hypertrophy cyanosis
Damage to deep peroneal nerve, what kind of gait?
steppage
steps of calc fracture repair
steps Insert Schantz pin for reduction, restore height, return heel to valgus, medial translation.
How to treat pyoderma gangrenosum?
steroids (this is seen with IBS)
which stewart classification is the jones fracture
stewart 1
Define modulus of elasticity
stiffness of an alloy (calcualted by dividing stress load by strain or defomration)
ephedrine use
stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anesthesia.
Oblique resection of 1st met head with normal WB portion of sesamoids left intact
stone
Stable angina with normal EKG, what is best test to check heart next?
stress EKG
diagnostic imagin to confirm ankle sprain
stress radiograph
What is best option to treat hematoma?
stretching
an equino varus deformity after a TMA will result in transfer ulceration where
sub 5th met base
Geodes aka
subchondral cysts have arthrtic changes and are found in joints.
difference between: subcutaneous calcaneal burisits vs subtendinous calcaneal bursitis
subcutaneous calcaneal burisits: between achilles tendon and skin vs subtendinous calcaneal bursitis: between achilles and calc
reiters disease tx
sulfasalazine
which melanoma occurs most often
superficial spreading melanoma 70% W256
what makes up the boundries of the popliteal fossa
superior medial: semi membranous/tendonosis superior lateral: biceps femoris infeior meidal: medial head of gastroc inferior lateral: lateral head of gastroc
Inferior muscular a aka
sural
what are the types of debridement (4)
surgical enzymatic mechanical autolytic
when do you order blood cutures for a DM ulcer
suspection of sepsis -require 3 samples each from different locations or same location 10 min apart -best when pt is feverish
Rowe 1B:
sustentaclum tali
what is the swag on a suture?
swag: where needle meets suture
Following removal of the proximal phalanx of the fifth digit, what is an appropriate surgical procedure for prevention of fifth digit flailing?
syndactilization
Most common malignancy in foot
synovial sarcoma
what does talipes refer to
talus and pes
best needle shape for subcutaneus tissue fascia: -referse cutting? -taper cutting? -taper point? -blunt point?
taper point
taper cutting needle used for (4)
tendon, ligament, blood vessels, periosteum
Interference screws aka
tendonesis screws
roof type for fracture blister: serous filled blister vs hemoragic blister Deroof?
tense vs flaccid Dont deroof a fracture blister
plate associated osteoporosis
term for plates with screw fixation that leads to impaired periosteal blood flow
purpose of a Grid in radiographs
the alternating strips of lead and aluminum absorbs the scatter
what makes up the lisfranc joint
the five tarsometatarsal joints involving three longitudinal columns 1.medial: first ray 2. middle: 2nd and 3rd tarsometatarsal joints 3. lateral: 4th and 5th tarsometatarsal joints
Levine's sign
the global position of heart attack; a fist clenched over the chest
"due proccess law" prevents the revocation of a pods liscens without?
the law requires a "hearing after notice"
how should a DMII handle thier long acting insulin leading up to surgery in a well controled DMII
the night before 2/3 pt's usual dose the morning of 1/2 pts usual dose mcglamery 58
piriformis sydrome
the piriformis muscle compresses the sciatic nerve.
what is an arthrocentsis
the process of gathering synovial fluid from a joint
Who decides standard of care?
the profession
define attenuation in reguards to a radigraph
the thicker a substance is the more it absorbs xrays
neuroma in relation to DTML
thickening of epineurium from entrapment *plantar to* DTML W12
what is a rim sign
thin layer of active infection surrounding normal bone, seen in OM on a T2 MRI
chemical matrixectomy is what type of burn
third degree
stage of CPRS: skin and muscle atrophy for more than 6 months
third stage: atrophic
major side effect to Heparin
thrombocytopenia (low levels of thrombocytes)
Stellwag's sign
thyrotoxicosis infrequent and/or incomplete blinking, accompanied by Dalrymple's sign
what is a blair fusion
tibial calcaneal fusion after a talectomy
ankle block (6)
tibial n saphenous n Medial Dorsal cutaneus n Deep peroneal n Intermedial Dorsal cutaneus n Sural
sesamoid position 3=
tibial sesamoid is paritaly bisected lateraly
Treatment for Dermatitis/Ecema
topical corticosteroids
Person with lichenus lesions around ankles at border of shoes with itching, what do you do?
topical steroid
under what catergory is a medical mal practice case (based on neglagence)
tort
what is Kite's error
touching or manipulating the calcaneus during the ponsetti technique
Difference between traditional vs Fallat and Bukholz
traditional: bisection of 4th and 5th Fallot and Buckholz: bisection of 4th and medial margin of proximal 5th
the most common SE for epinephrine is
transient tachycardia after inadvertent intravascular injection
What 2 planes do you image in ultrasound?
transverse (A) produces a coronal Longitudinal (B) produces a sagittal section
what makes up the Cruciate Anastamosis
transverse br of MFC transverse br of LFC Inferior Gluteus 1st Perforating
Cincinnati Incision
transverse incision that involves extensive dissection of the posterior, medial and lateral ankle
Kite is 50 and cc is 25 on ap, lateral calc inclin is 20? What is the plane of deformity?
transverse. kites normal: <25 calc inclin normal: 25 cc angle normal: 0-5
outlast shoe
transvese plane correction for metatarsus adductus (shoe that is diected outward)
Positive PPD and negative CXR what do you do?
treat with isoniazide
name the acetate injectibles
triamcinolone (kenalog)
Ankle fx looks like SH2 on one view and SH3 on another view,=
triplane fracture
A 30-year-old male, who had a resection of a calcaneonavicular bar at age 11, exhibits fixed valgus deformity of his foot. Radiographs demonstrate the recurrence of a calcaneonavicular coalition with subtalar joint degeneration and talar beaking. What is the appropriate surgical treatment?
triple arthrodesis
T:F Pt with CHF don't use calcium-channel blocker
true
T:F you can use ex fix on comminuted fractures
true
T:F you can use ex fix on open fractures
true
Salter Harris: Transverse minor fracture through growth plate without shortening
type 1
type of collagen in maturation phase of healing creating scar
type 1
type 1 vs 2 osteoporosis
type 1: post menopausal (increased osteoclasts), decreased PTH type 2: age (decreased osteoblasts), increased PTH
type 1 error vs type 2
type 1: rejecting a true null hypothesis. type 2: fail to reject a false null hypothesis
Salter Harris: Through growth plate and traveling above into the metaphysis. Its Extra-articular with minamal shortening. no functional limitations after healing
type 2
Salter-Harris Fracture: Through the growth plate and traveling below into the epiphysis. Intra-articular and can cause shortening
type 3
Pt presents with bifid (cleft) epiphysis, which salter harris classification must you rule out:
type 3 a cleft is a normal varient withing growth plates that can resemble a fracture. xrays will help rule out fracture as fracture shoes sigsn of healing in 2-3 weeks
Partial Incongrutiy of mets 2-4 (lateral displacement)
type B2 Hardcastle
most common salter harris fractures
type II thurstan holland sign
thread hole, pilot aka vs glide hole
underdrill vs overdrill
thompson procedure indication
underlapping 5th toe
midtarsal joint at contact?
unstable
orthotripsy ie
using soundwaves to treat Plantar fascitis reduces inflammation ie OssaTron
A patient presents with a brachymetatarsia on the fourth metatarsal right foot. What is the limiting factor when considering the maximum length that may be added to the metatarsal?
vascular length
Major SE for Propofol (1)
vasodilatin SP204
medial superior genicular artery supplies blood to (2)
vastus medialis articularis genu
telangiectasis is an early sign of_______disease (arterial or vein)? diameter size? aka?
vein. <1mm in diameter. aka spider veins
function of a flange on orthotic
vertical exetension of basic orthotic to *more control* supination or pronation
Nitroous oxide has a high or low MAC?
very high (>100%)= not very potent W56
if a pt is in shock and loosing blood, why cant you just give him a vassopressor
vessels are max contronstricted
vertical mattress stich vs retention stich
vetical: far-far, near-near retention: far-near, near-far
increase in lymphcyte only
viral infection
which vit B can help with neuropathy
vit B12
Homeless man with MCV 110 (macrocytic), what is cause of anemia?
vit B12 def
Pathology? -Crowe sign -Lich nodules
von Recklinghausen disease -Freckling of the axilla - hamartomas in the iris but doesnt affect vision
wart vs callus skin lines go around lesion
wart
wart vs callus: pain with lateral pressure
wart
when is okay to do arthrodesis of the AJ in equinus?
weak quads
wet vs dry gangrene
wet: infected dry: non-infected
What does Mattles test and Simmonds test?
when a person is prone with knee at 90 and when a pt is prone the postion of the foot in a normal non achilles torn tendon is *plantarflexed*
coleman block test determines what
whether a *REARFOOT varus deformity is flexible or rigid.* Pt is placed on wooden block 1 in thick so that the enitre foot is standing on the block exept the medial forefoot. -In a *flexible rearfoot varus:* the 1st metatarsal will plantarflex down to the ground and the rearfoot varus will evert into a corrected position telling us that the varus deformity is caused by a plantarflexed first ray (this needs to corrected by doing a dorsalflexory wedge osteotoomy of first metatarsal) -In a *rigid rearfoot varus*: the foot will not correct indicating that an isolated forefoot sx will not correct the varus deformity and would need a rearfoot surgical correction such as Dwyer (lateral closing wedge
Muehrcke's lines nail
white transverse bands occurring in pairs- hypoalbuminemia
white toe vs blue toe
white: arterial problem blue: venous problem
issue with over countersinking? what can be placed if done
with a weakened cortical bone, the screw may sink into cancellous bone a washer
occurence malpractice policy vs claims made malpractice policy
with occurence, the doctor is covered even after the occurence malpractice policy expires vs claims made malpractice, the doc is not covered when the policy expires.
what is libel
written defamation
Form of ionizing radiation
x-rays, gamma rays, neutrons
how to change mAs with wet plaster
x3
blood culture taken
x3, x 3 different places, 30 min apart
Light source for ankle scope from most powerful to least powerful: (3)
xenon most powerful, metal halide, tungsten least powerful
Can punitive damages be awarded in a successful suit for slander?
yes
difference between ausitin and youngswick bunionectomy
youngswick has an additional cut to take out a piece of bone thereby correcing metatarsus elevatus
gastrosoleus zones
zone 1: gastroc origin zone 2: distal gastroc to disal soleus before achilles zone 3: achilles