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Crozer Flashcards

1
Q

What attaches periosteum to bone?

A

Sharpey fibers

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2
Q

Eponym for the anterior inferior tibiofibular ligament?

A

Bassett’s ligament

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3
Q

Sesamoid occasionally found in tendon of lateral grastroc head?

A

Fabella

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4
Q

Sources of blood supply to the talus?

A
  1. Artery of the Sinus Tarsi

2. Artery of the Tarsal Canal

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5
Q

What should the peaks and troughs be for Vancomycin?

A

Peak: 15-30 mg/mL
Trough: < 10 mg/mL

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6
Q

How do you treat Red Man Syndrome?

A

Antihistamines (e.g. Benadryl)

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7
Q

What can beta-lactams cause?

A

Leukopenia

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8
Q

What drug sensitivity do you look at to see if someone has MRSA?

A

Oxacillin

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9
Q

Difference between cellulitis and erysipelas?

A

Cellulitis-confined superficial infection

Erysipelas-superficial infection that spreads to lymphatics

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10
Q

What happens to WBC count after surgery?

A

May actually increase slightly post-op day 1 and 2.

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11
Q

Following PRBC transfusion, when will H/H changes be seen?

A

3 hours, thus order new labs to be drawn 4 hours after last unit given.

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12
Q

What should be given if Na is low?

A

NSS or regular salt

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13
Q

What should be given if K is low?

A

K-Dur and/or potassium rich foods

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14
Q

What should be given if K is high?

A

Calcium gluconate, sodium bicarbonate, dextrose with insulin, kayexalate

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15
Q

What’s more important, BUN or Cr?

A

Cr. BUN is influenced by hydration state. If BUN is high but Cr is normal, patient is probably dehydrated. If both are high, then it’s probably renal damage.

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16
Q

What can cause an elevated PT/INR?

A

Coumadin, Malnutrition, Alcoholism, Abx, Vitamin K disorders

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17
Q

What pathways do PTT/PT check?

A

PTT-Intrinsic (“PITT”)

PT-Extrinsic (“PET”)

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18
Q

What are the reasons for post-op fever?

A
  1. Wind (12-24 hrs)-atelectasis (tx with pulmonary toilet), pneumonia
  2. Water (24 hrs)-UTI
  3. Walk (48 hrs)-DVT, PE
  4. Wound (72 hrs)-post-op infection
  5. Wonder drug (anytime)-drug fever
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19
Q

When do fever peaks occur?

A

Between 4-8 PM.

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20
Q

What test can you look at if you suspect someone at risk for malignant hyperthermia?

A

CPK (elevated in 79% of pts with it)

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21
Q

What is the only local anesthetic with vasoconstriction?

A

Cocaine

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22
Q

What should be given for an indomethacin overdose?

A

Benadryl (reduces serotonin and histamine release)

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23
Q

Triad of pulmonary embolism?

A

Dyspnea, Chest pain, Hemoptysis (although tachycardia is more common)

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24
Q

Risk factors for DVT?

A 
"I AM CLOTTTED"
Immobilization
Arrhythmia
MI history
Coagulable state
Longevity (old age)
Obesity
Tumor
Trauma
Tobacco
Estrogen
DVT history
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25
What can be ordered to diagnose DVT?
Doppler US D-Dimer Venogram
26
How do you reverse Lovenox?
Recombinant Factor VII
27
Signs of hypoglycemia?
Nervousness, tachycardia, diaphoresis, nausea, headache, confusion, tremor, seizure, coma
28
How much lengthening per day is typical for callus distraction?
1 mm per day
29
Phosphate versus acetate steroids?
Phosphate-soluble with shorter half-life | Acetate-insoluble with longer half-life
30
What is given for acetaminophen overdose?
Acetylcysteine
31
Most common clinical pattern of onychomycosis and it's most common infecting organism?
Distal subungual onychomycosis; Trichophyton rubrum
32
When evaluating bunion, what does tibial sesamoid position tell you?
Abnormal effects of the adductor tendon and FHB.
33
What x-ray measurements evaluate a haglund deformity?
Parallel pitch lines Fowler & Philip Angle (44-69˚, > 75˚ is abnormal) Total Angle of Ruch (
34
What may falsely elevate an ABI?
Vessel calcification/non-compressible vessel
35
Most common type of melanoma?
Superficial spreading melanoma
36
What is the Badgley procedure?
Surgical resection of coalition or bar with interposition of muscle belly
37
What is the technique for correction of clubfoot?
Ponseti technique - Serial casting - Correct FF and RF deformities first, then correct ankle equinus
38
What are the types of bunions?
Positional: HA > PASA + DASA Structural: HA
39
Angles for assessing Tailor's bunion?
Fallat & Buckholz IM angle: 6˚ (8.7˚ is pathologic) | Fallat & Buckholz Lateral Deviation angle: 2.64˚ (> 8˚ is pathologic)
40
STJ Axis?
Frontal-48˚ Transverse-42˚ Sagittal-16˚
41
Longitudinal MTJ Axis?
Frontal-75˚ Transverse-15˚ Sagittal-9˚
42
Oblique MTJ Axis?
Frontal-38˚ Transverse-52˚ Sagittal-57˚
43
What angles can be used to assess intra-articular calcaneal fractures?
Bohler's Angle: 25-40˚ (decreases with fx) | Angle of Gissane: 125-140˚ (increases with fx)
44
How to calculate daily fluid input requirement?
First 10 kg x 100 = 1000 mL/day Second 10 kg x 50 = 500 mL/day Remaining kg x 20 = _____
45
How to calculate IV fluid input rate?
"421" rule First 10 kg x 4 = 40 mL/hr Second 10 kg x 2 = 20 mL/hr Remaining kg x 1 = ____
46
When should PRBC transfusion be given?
If Hbg < 8 or Hct is < 24.
47
What type of screw has a fluted tip?
Self-tapping
48
What is a Keith needle?
Straight needle
49
Order of lateral release for a McBride?
1. Extensor hood 2. ADH tendon release 3. Fib sesamoid lig 4. Lat collateral lig 5. FHB 6. Fibular sesamoid excision (if performing)
50
Difference between a Vogler, Kalish, and Youngswick?
Vogler-apex at metaph-diaph junction Kalish-long-arm Austin with angle of 55˚ Youngswick-Austin with dorsal slice to decompress and plantarflex
51
What are surgical procedures for pes planus and their plane of correction?
Transverse: Evans, Kidner, CC distraction arthrodesis Sagittal: Cotton, Young, Lowman, Hoke, Miller, Cobb Frontal: Koutsi, Dwyer, Chambers, Gleich, Baker-Hill, Lord
52
What imaging study can distinguish between hypertrophic and atrophic non-unions?
Bone scan
53
Best study for evaluating AVN?
MRI (decreased signal intensity on T1 and T2)
54
ASA Classification
1-healthy pt 2-mild systemic disease 3-serious systemic disease 4-disease that is constant threat to life 5-patient not expected to survive w/o emergency treatment 6-pt for organ harvest
55
How does bone stimulator work?
Piezoelectric principle-side under compression makes negative charge that leads to bone growth
56
Sequence of release for hammertoe surgery?
1. Arthroplasty PIPJ 2. Extensor hood recession 3. EDL/EDB tenotomy 4. MPJ Capsulotomy 5. Flexor plate release 6. Flexor to extensor transfer 7. MT osteotomy
57
What is the lag time for presentation of osteomyelitis on x-ray?
10-14 days
58
How do assess someone for trauma?
``` "ABCDE" Airway Breathing Circulation Disability (neuro status) Exposure of pt and environment control ```
59
What is the Vassal principle?
Initial fixation of the primary fx will assist in stabilization of secondary fx
60
Are dorsal or plantar Lisfranc dislocations more common?
Dorsal because plantar ligaments are stronger
61
What are the fractures with the eponyms Tillaux-Chaput, Wagstaff, Volkman, Cedell, Foster, and Bosworth?
Tillaux-Chaput: avulsion of anterior-lateral tibia Wagstaff: avulsion of anterior-medial fibula Volkman: posterior mal fx Cedell: posterior medial process fx Foster: fx of entire posterior process Bosworth: lateral mal fx with ankle displacement
62
When should a posterior mal fx be fixated?
Fragment is > 25% of posterior mal
63
Most common benign and malignant primary bone tumors?
Benign-Osteochondroma | Malignant-Multiple Myeloma
64
What are the stages of wound healing?
1. Inflammatory (lag) phase 2. Proliferative (repair) phase 3. Remodeling (maturation) phase
65
What is Santyl?
Collagenase-enzymatic debrider that digests collagen (fibrotic tissue) in wounds
66
What is minimum ABI necessary for wound healing?
Non-DM: 0.35 | DM: 0.45
67
What is Integra, Apligraf, and GraftJacket?
Integra: bilayer graft of bovine tendon collagen and a silicone layer to control moisture Apligraf: bilayer graft from neonatal foreskin with dermal and epidermal layers GraftJacket: extracellular matrix from human tissue with intravascular channels
68
What are phases of a bone scan?
1. Blood Flow (2-3 sec) 2. Blood pool (2-3 min) 3. Bony uptake (2-3 hrs) 4. Delayed (24 hrs)
69
What is Regranex?
PDGF-1 (Platelet derived growth factor)
70
What is Integra?
Bilayer graft composed of bovine tendon collagen and a silicone layer to control moisture loss
71
What is Oasis?
Extracellular graft matrix derived from porcine, small intestine submucosa
72
What is Apligraft?
Bilayer graft derived from neonatal foreskin with dermal and epidermal layers
73
What is GraftJacket?
Extracellular graft matrix derived from human tissue with intact vascular channels
74
What is TissueMend?
Acellular collagen matrix derived from fetal bovine dermis
75
What is Endoform?
Collagen ECM that's bovine derived.
76
What is Promogran?
55% collagen, 45% oxidized regenerated cellulose
77
What is Repara?
Calcium alginate, contains silver; for draining infected wounds
78
What is Iodosorb?
Cadexomer iodine; cleans by absorbing fluid, removing exudate, slough, and debris
79
Sneppen Talar Body Classification
``` Type 1: compressive fracture of talar dome Type 2: shearing fx of talar body -2A: coronal shearing force -2B: sagittal shearing force -2C: transverse shearing force Type 3: fx of posterior tubercle Type 4: fx of lateral process Type 5: crush fx ```

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