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Question 1

Three phases of skin graft healing

Answer 1

24-48 hrs Plasmatic Inhibition passive nutrient absorption

Day 3 Inosculation - Capillary buds hit graft

Day 5 Angiogenesis with new blood vessels growing into the graft and graft is vascularized.

Question 2

How much lengthening from a Z plasty with 60 degree angles?

Answer 2

75% increase in skin length

Question 3

Where is the apex of the V in a V to Y placed in relation to skin tension?

Answer 3

Placed a the point of maximal skin tension

Question 4

How many WBC in inflammatory vs Septic arthrocentisis?

Answer 4

WBC in inflamatory ~ 2,000 - 75,000

Septic is >100,000

Question 5

Which toe joint do you see rheumatoid arthritis?

Answer 5

PIPJ

Effects the MTPJ’s too
Can have boutonnier deformities and swan necks

Question 6

Herberdene nodes

Answer 6

Osteoarthritis with swelling of the DIPJ’s

Question 7

Bouchard nodes

Answer 7

Osteoarthritis with swelling of he PIPJs

Question 8

What is the order of closure for physeal plate in children? Ankle

Answer 8

keletal growth typically continues until 16 years in males and 14 years in females. The distal tibia physis closes in a predictable manner: central, anteromedial, posteromedial, then lateral. The lateral aspect is most often injured in adolescents as it is last to close.

Question 9

How far should the Wicks catheter be placed from the site of injury when measuring for compartment syndrome?

Answer 9

at least 6 cm

Question 10

Least malignant form of melanoma?

Answer 10

Lentigo maligna melanoma

Question 11

Cafe au lait spots is most commonly associated with?

Answer 11

Neurofibromatosis

McCune Albright Syndrome

Question 12

Which diabetic meds increase the risk of heart failure exacerbation in the perioperative timeframe?

Answer 12

The glitazones
AKA pioglitazone
Due to fluid retention with sodium retention

Question 13

What are the drugs of choice for patients with Paget’s disease?

Answer 13

Paget’s disease of bone (osteitis deformans) involves accelerated bone resorption followed by deposition of dense, chaotic, and ineffectively mineralized bone matrix. Bisphosphonates, which decrease bone resorption by inhibiting osteoclast resorption, are the treatment of choice.

Question 14

One unit of packed red blood cells (PRBC) will raise hematocrit (Hct) by what percentage?

Answer 14

3%

Normal levels of hematocrit for men range from 41% to 50%. Normal level for women is 36% to 48%.

Question 15

What is the Fowler Osteotomy?

Answer 15

A medial cuneiform and cuboid osteotomy to help with metatarsus adductus

Question 15

What joints in the foot are most commonly affected by Reiters disease?

Answer 15

Metatarsophalangeal joint followed by the calcaneus then ankle jt

Question 16

What is the medication Pletal used for?

Answer 16

Pletal is also known as Cilostazol and is used for the treatment of claudication.

Question 16

What joints in the foot are most commonly affected by Reiters disease?

Answer 16

Metatarsophalangeal joint followed by the calcaneus then ankle and knee

Question 17

most common type of soft tissue sarcoma

Answer 17

Malignant fibrous histiocytoma

Question 17

Do the stupid five W’s of post-op fever

Answer 17

Five common causes of fever- Five W’s: (Wind, Water, Wound, Walking, Wonder drugs).
WIND: 12-24 hours = pulmonary atelectasis and post-op hyperthermia. WATER: 24 hours = UTI, urinary retention.
WALK: 48 hours = PE, DVT.
WOUND: 72 hours = surgical site infection.

Question 18

Describe how Kvp and MA are correlated with one another?

Answer 18

A 15 percent increase in Kvp is equal to doubling the mAs. However , if you want to maintain radiographic density by increasing kvp by 15 percent, you need to cut your mass in half

Question 18

Xray of the cervical spine shows romanus lesions and bridging syndesmophytes

Answer 18

Ankylosing Spondylitis
Skeleton of an AS patient include florid anterior spondylitis (Romanus lesions), florid discitis (Andersson lesions), insufficiency fractures of the ankylosed spine, syndesmophytes, enthesitis of the interspinal ligaments, ankylosis. Romanus lesion, are the lesions of disco-vertebral unit. The inflammatory changes result in the squaring of the verterbare with progessive loss of lumbar lordosis.

Question 19

Toxic doses of lidocaine and marcaine w/wo epi

Answer 19

Toxic dose for Lidocaine plain = 4.5mg/kg (300mg) and Lidocaine with epinephrine = 7mg/kg (500mg). Toxic dose for Marcaine plain = 3mg/kg.

Most consistent practice to date is with single doses of Marcaine up to 225 mg with epinephrine 1:200,000 and 175 mg without epinephrine.

Question 19

Club foot Posteromedial release

Answer 19

The following are components of a PosteroMedial Release: The approach should be to address the release in quadrants
Plantar : plantar fascia, Abductor Hallucis and FDB, long and short plantar ligaments

Medial : identify medial structures, release tendon sheaths talonavicular and subtalar release, lengthening tibialis posterior and also FHL, FDL

Posterior : ankle and subtalar capsulotomy, esp. releasing posterior talofibular and the calcaneofibular ligaments

Lateral : identify lateral structures, release peroneal sheaths, calcaneocuboid, complete of talonavicular and subtalar release

“Similar to the Ponsetti Method, the aim is to obtain forefoot derotation in order to reduce medial talonavicular joint dislocation before correction of hindfoot equinus

Question 20

Describe axonotmesis, neurotmesis, and neurapraxia

Answer 20

Axonotmesis involves an injury to the peripheral nerve’s axon and myelin sheath, but the endoneurium, perineurium, and epineurium remain intact.
A complete transection or crushing injury of a peripheral nerve (neurotmesis) has no potential for regeneration unless the endoneurium and axons are reapproximated.

Lesser injuries with the endoneurial structure intact, with (neuropraxia) or without (axonotomesis) axonal continuity, have a better prognosis for axonal regrowth and recovery of function.

Question 21

Three phases of skin graft healingSin

Answer 21

24-48 hrs Plasmatic Inhibition passive nutrient absorption

Day 3 Inosculation - Capillary buds hit graft

Day 5 Angiogenesis with new blood vessels growing into the graft and graft is vascularized.

Question 22

Single ligament repairs with tendon autograft names

Answer 22

AKA “Newl”

Nilson, Evans, Watson jones, Lee

Question 23

Most important factor for skin graft contracture?

Answer 23

Thickness!

The thinner it is the more likely it is to retract

Question 24

Eckert and Davis Classification System

Answer 24

1, the retinaculum is elevated off the lateral malleolus with the tendons now located between the fibula and retinaculum.

stage 2, the fibrocartilaginous ridge is elevated with the retinaculum attached and the tendons displaced beneath this ridge.

stage 3, a small portion of the lateral malleolus is avulsed off and the tendons now located beneath this fragment of bone.

Stage 4 was added later on: Involving a tear of the superficial peroneal retinaculum from its posterior attachment.

Question 25

Normal INR, PT, PTT

Answer 25

normal INR = ~1
An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin and would be at increased risk of bleeding.
A normal PTT time = 25 to 35 seconds.
A normal PT time = 11 to 13.5 seconds. (SAME AS INR BUT IN SECONDS)