All Questions

Question 1

hyperphalangism

Answer 1

inc. # of phalanges

Question 2

brachydactyly

Answer 2

abnormal shortness of toes

Question 3

syndactyly

Answer 3

fusion or fleshy webbing b/w digits in hands or feet

Question 4

hemimelia

Answer 4

absence of all or part of the distal limb, the proximal limb is normal

Question 5

amelia

Answer 5

congenital ABSENCE of limb or limbs

Question 6

phocomelia

Answer 6

congenital absence of the proximal limbs, such as hands or feet that are attached to the trunk by an anomolous segment

Question 7

sympodia

Answer 7

fusion of the lower extremities

Question 8

polydactyly

Answer 8

presence of supernumerary digits on the hands or feet

Question 9

most deformed bone in clubfoot deformity

Answer 9

Talus

• the foot is rotated medially beneath the talus
• head of talus is palpable on lateral aspect of dorsum of the foot (due to inward/backward displacement of the navicular)
• head of the talus is adducted and plantarflexed (*head of the talus is most deformed bone)

Question 10

mechanical methods of hemostasis

Answer 10

• direct pressure
• vessel ligation (sutures, staples, ligating clips)
• bone wax
• tourniquet application
• compressive dressings
• acrylates

Question 11

acrylates

Answer 11

adhere to the tissue and provide a mechanical blockage of hemorrhage

(mechanical method of hemostasis)

Question 12

aluminum chloride hexahydrate:

use

Answer 12

• chemical cautery solutions to control bleeding after minor surgical procedures
• cause hemostasis by precipitating proteins in the tissues and occluding smaller vessels

Others include: ferric subsulfate solution and silver nitrate

Question 13

thermal/energy methods of hemostasis

Answer 13

• electrosurgery (high-frequency alternating current for cutting, coag, and vaporizing tissues)
• ultrasonic devices
• lasers

Question 14

chemical methods/topical

methods of hemostasis

Answer 14

• pharmacologic agents
• topical hemostatic products
• passive hemostasis

Question 15

pharmacologic agents

for hemostasis

Answer 15

• epinephrine
• vitamin K
• protamine
• desmopressin
• lysine analogues

Question 16

topical hemostatic products

Answer 16

• passive
  
  • e.g. bovine collagen, cellulose, porcine gelatins, polysaccharide spheres
• active
  
  • topical thrombins
  • e.g. bovine, pooled human plasma, recombinant

Question 17

in lateral projection of foot, which structure is targeted by the x-ray beam?

Answer 17

third to fifth metatarsal bases

• Film cassette is placed vertically, one-half of the exposable portion of the orthoposer slot
• medial aspect of the foot is next to the film and the opposite in angle and base of gait
• tube is angled 90 degrees from vertical or perpendicular to the cassette and targeted at 3-5 met bases

Question 18

what is the talar neck view

on x-ray called?

Answer 18

modified AP (Canale, Kelly)

• helpful to assess degree of fx displacement and adequacy of reduction
• best to demonstrate talar neck, varus angulation, and medial malposition or dorsal displacement of the neck
• lateral border rotated 15 degrees off table

Question 19

what agents are BEST for use in

PMMA antibiotic beads?

Answer 19

vancomycin and aminoglycosides (gentamycin, tobramycin, cefazolin)

• broad spectrum of activity
• low incidence of rxn
• heat stability
• extensive research

Question 20

what agents can be used with PMMA antibiotic beads?

Answer 20

• aminoglycosides
• vancomycin
• cefazolin, cefotetan, ceftriaxone, ceftazidime
• penicillin V
• nafcillin
• amoxicillin
• ticarcillin, piperacillin
• doxycycline

Question 21

if patient has elevated liver enzymes pre-op,

which anesthetic has lowest liver metabolism?

Answer 21

Desflurane

*in clinical practice, patients with end-stage liver disease are most commonly treated with nitrous oxide gas, isoflurane, desflurane, and sevoflurane

Question 22

which anesthetic agents have the HIGHEST liver metabolism?

(and should be avoided in patients with end-stage liver disease)

Answer 22

Halothane has the highest liver metabolism

Question 23

large D-shaped osseous structure adjacent to navicular tuberosity with cartilaginous attachment b/w accessory navicular and tuberosity;

what is the classification based on Lawson?

Answer 23

Type 2

(type 2 accessory navicular is larger, semi-circular in shape, and lies immediately next to tuberosity)

Question 24

Lawson classification

Answer 24

differentiates the various forms of accessory navicular

types I-III

Question 25

hx and MOI of: ## Footnote **peroneal subluxation and traumatic rupture of peroneal retinaculum**

Answer 25

**rapid forced dorsiflexion of the inverted foot** -→ leads to superior peroneal retinaculum tear * pain lateral aspect of ankle, heard sound * palpable cord w/ forced inversion & DF of ankle lateral to lateral mall * xrays are negative

Question 26

if xrays are negative following suspected tendon injury, what next?

Answer 26

MRI without contrast of left lower extremity

Question 27

**where are macrovascular occlusive lesions** more likely to be **found in diabetics**, as compared to non-diabetics?

Answer 27

Tibial arteries * in diabetics, occlusive lesions commonly involve the infragenicular (tibial) arteries

Question 28

**where are macrovascular occlusive lesions** more likely to be **found in _non-diabetic_ patients?**

Answer 28

more likely to have occlusive lesions involving the **superficial femoral or popliteal arteries**

Question 29

sniffing position

Answer 29

**extend the head** and **flex the neck** * best position to place the patient's head & neck into for anesthesia * allows for alignment and is easiest to position the laryngoscope

Question 30

if you don't hear breath sounds after intubating a patient, what is the most likely cause?

Answer 30

if you hear no breath sounds, you are most likely intubated in the esophagus If you hear breath sounds, but only on the right and not the left -→ you are most likely in the R main stem bronchi

Question 31

proper intubation aims for which level?

Answer 31

placed into the windpipe (**trachea**) through the mouth or nose

Question 32

HPI: painful “growth” following a trauma over a year ago; cancellous bone growing from base of DP w/o destructive changes

Answer 32

**subungual exostosis** * bony growth most commonly found on hallux * MC in young adults, often assoc w/ hx of trauma or infxn * radiographically appear as cancellous bone growth w/o destructive changes

Question 33

subungual osteochondroma: radiographic presentation

Answer 33

**appear as confluent w/ that of the underlying bone** * rare, benign bony tumor that usually involves the phalanges of the toes or fingers * MC in adolescents

Question 34

bone marrow signal changes on MRI in: ## Footnote **osteomyelitis**

Answer 34

* LOW signal on T1 * HIGH signal on T2 and STIR *same changes as in ACUTE neuroarthropathy*

Question 35

bone marrow signal changes in: ## Footnote **chronic neuroarthropathy**

Answer 35

Normal/Low signals on both T1 and T2 *differentiates from acute neuroarthropathy & OM, which have high signals on T2 & STIR*

Question 36

what angle for AP radiograph?

Answer 36

AP radiograph requires an angle of ~10-15° to be perpendicular to the metatarsals; * dorsiplantar projection * central ray parallel to medial and intermediate cuneiform and medial lisfranc joint space * high arch requires \>15 degree angle

Question 37

hypothyroidism (elevated TSH, dec. T4 and T3) is characterized by:

Answer 37

* bradycardia * cold intolerance * lethargy and fatigue * weight gain (despite decreased appetite) * constipation

Question 38

what is an **alternative** to ankle fusion in the case of a severely arthritic ankle?

Answer 38

ankle arthrodiastasis

Question 39

ankle arthrodiastasis

Answer 39

* an effective joint-sparing technique indicated for end-stage ankle arthritis; * generally better for younger individuals in 20-40s

Question 40

contraindications for ankle arthrodiastasis

Answer 40

* active infection * vascular impaired limb * poor soft tissue envelope * significant planar deformities

Question 41

vascular pattern in children

Answer 41

does NOT penetrate the growth plate, therefore blood-borne organisms **CANNOT cross into the epiphysis** of the tubular bone therefore in hematogenous OM in a child, only the diaphysis and metaphysis are affected

Question 42

lag effect: 3 criteria

Answer 42

1. screw in the **near fragment** (threaded or non-threaded), **must glide freely** in the near side screw hole w/o engaging the bone 2. threads in far side fragment screw hole must continue to **progress thru the bone as screw turns** and must **firmly grip the bone w/o stripping** 3. advancement of the head of the screw must be **solidly arrested on surface of NEAR side**

Question 43

peroneus longus tendon transfer: procedure

Answer 43

*involves severing peroneus longus tendon as it crosses over cuboid bone → transferring it under extensor retinaculum to the region of the 3rd cuneiform → distal remnant of the peroneus longus is then tenodesed into peroneus brevis*

Question 44

peroneus longus tendon transfer: indications

Answer 44

* peroneus longus overdrive * *due to a sub-first metatarsal diabetic foot ulcer* * anterior muscle group weakness or paralysis * drop foot * chronically varus unstable ankle w/ anterolateral dislocation of the talus, resulting in chronic peroneal dysfunction

Question 45

total ankle arthroplasty: absolute contraindications

Answer 45

* high physical demands * poor vascular status * significant neuropathy * infection * neuromuscular deficits * avascular necrosis of the talar body * chronic pain syndrome * noncompliance

Question 46

total ankle arthroplasty: indications

Answer 46

* patients who have an adequate bone stock * intact neurovascular status * neutral ankle alignment * intact deltoid ligaments * not immunosuppressed

Question 47

total ankle arthroplasty: relative contraindications

Answer 47

* obese patient *(the increased forces make it prone to failure)* * poor bone stock * immunosuppression * smoking * ankle malalignment * history of septic arthritis * diabetes

Question 48

dropfoot caused by Charcot-Marie-Tooth: best tendon for transfer?

Answer 48

tibialis posterior *considered a “workhorse” tendon in cavus foot deformity (one of the last to atrophy); by transferring tendon through interosseous membrane to dorsum of the foot, supination is decreased and foot can actively dorsiflex*

Question 49

pre-operative EKG is recommended for which patients?

Answer 49

those with intermediate risk surgical procedures when patient has at least 1 known risk factor; risk factors include: cerebrovascular disease, CHF, creatine levels \> 2.0 mg/dL, insulin-dependent DM, or ischemic cardiac disease

Question 50

what foot type can be caused by an accessory navicular?

Answer 50

flexible flatfoot | (increase in hindfoot valgus)

Question 51

life-threatening risk factor with IM nailing

Answer 51

fat embolism