Crozer- Clinical Podiatry Flashcards

1
Q

clinical patterns of tinea pedis? common infecting org?

A

chronic (moccasin/papulosquamous-trichophyton rubrum
acute (interdigital/vasicular)-trichophyton mentagrophytes
Ulceration-trichophyton mentagrophytes w pseudomonas or proteus

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2
Q

patterns of onychomycosis? infecting org?

A

Distal subungual onychomycosis (DSO) ~ 90%
 Most common
 Trichophyton rubrum
Proximal subungual onychomycosis (PSO) ~ 1%
 Seen in immunocompromised patients
 Trichophyton rubrum
Superficial white onychomycosis (SWO) ~ 10%
 Trichophyton mentagrophytes
Candidal onychomycosis
 Candida albicans

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3
Q

what test confirms tinea pedis or onychomycosis

A

KOH prep of skin/nail. septate

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4
Q

how does lamisil work

A

inhibits ergosterol syn

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5
Q

whats phenol

A

carbolic acid

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6
Q

if pt allergic to all locals what can you use during a nail avulsion?

A

Saline block (pressure block)
pressure cuff
benadryl block

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7
Q

causes of hallux varus

A
Congenital
 Clubfoot
 Metatarsus adductus
Traumatic
 MPJ dislocation
 Fracture
Iatrogenic
 Overcorrection of intermetatarsal angle
 Excessive resection of medial eminence or staking the head
 Fibular sesamoidectomy
 Overaggressive capsulorrhaphy
 Bandaging too far into varus
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8
Q

Staking the head

A

excessive resection of 1st met head-> varus

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9
Q

flexor stabilization hammertoes

A

Most common
 Stance phase
 Flexors overpower interossei
 Pronated foot

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10
Q

extensor substitution

A

Swing phase
 Extensors overpower lumbricals
 Anterior cavus, ankle equinus, anterior compartment muscle weakness

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11
Q

Flexor substitution

A

Least common
 Stance phase
 Deep compartment muscles overpower interossei
 Supinated, high arch foot or weakened Achilles

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12
Q

whats the silfverskiold test

A

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

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13
Q

Lachman test

A

Determines if there is a plantar plate tear or rupture. While stabilizing the metatarsal, a dorsal
translocation of the proximal phalanx greater than 2 mm is suggestive of rupture.

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14
Q

Mulder sign

A

Identifies a Morton neuroma by a palpable click when compressing metatarsal heads and
palpating the interspace

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15
Q

sullivan sign

A

separation of digits caused by a mass in the interspace

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16
Q

q angle

A

btwn axis of the femur and the line between the patella and tibial tuberosity

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17
Q

edema with a cast. when to worry?

A

if down in AM know it is gravity edema.

if doesn’t go down=abnormal

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18
Q

Stages of raynauds?

A

white-> blue-> red
Pallor – spasm of digital arteries
Cyanosis – deoxygenation of blood pools
Rubor – hyperemia

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19
Q

ABI normal?

A
Ankle Brachial Index – compares ankle to arm pressures
Normal 1
Intermittent claudication 0.6-0.8
Rest pain 0.4-0.6
Ischemic ulcerations <0.4
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20
Q

what may falsely elevate the ABI?

A

Vessel calcification/non compressible vessels

21
Q

What other tests are typically performed with an ABI?

A

Segment pressures
 Measured at high thigh, above the knee, below the knee, ankle, midfoot, and toe
 Normal 70-120 mm Hg
 Drop between segments >30 mm Hg indicate disease in vessel above
Pulse volume recordings (PVRs)
 Normal waveforms are triphasic
 Waveforms are widened and blunted with severe disease

22
Q

most common skin cancer?

A

basal cell carcinoma

23
Q

what skin cancer is cauliflower like

A

Squamous cell carcinoma

24
Q

most common melanoma

A

superficial spreading melanoma- any part of body

25
Q

most malignant melanoma

A

nodular melanoma- misdiagnosed as pyogenic granuloma

26
Q

most benign melanoma

A

lentigo melanoma

27
Q

type of melanoma of palms soles and nail beds

A

acral lentiginous melanoma

28
Q

hutchinson sign

A

pigment changes in the eponychium seen w subungual melanoma

29
Q

what conditions associated w plantar fibromatosis

A

ledderhose disease, dupuytren contraction, peyronie disease

30
Q

another name for congenital convex pes valgus

A

vertical talus

31
Q

radiographic findings of CCPV

A

calc in equinus, plantarflexed talus, dorsally dislocated navicular, increased TC angle

32
Q

what additional radiographs for neonates with ccpv

A

lumbosacral films

33
Q

What are three coalitions of the rearfoot?

A

talocal, calcnav, talonav

34
Q

percent tarsal coalitions bilateral

A

50%

35
Q

what coalliton is most symptomatic

A

CN

36
Q

what coalliton is most asymptomatic

A

TN

37
Q

what coalliton is most common

A

TC> CN>TN

38
Q

which TC facet is most commonly fused

A

Medial > anterior > posterior

39
Q

what are ages of fusion

A

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

40
Q

What are radiographic findings of tarsal coalitions?

A

 Rounding of lateral talar process
 Talar beaking due to increased stress on talonavicular ligament
 Asymmetry of anterior subtalar facet
 Narrowing or absence of middle and posterior subtalar facets
 Halo sign – circular ring of increased trabecular pattern due to altered compressive forces
 Anteater sign – C-N coalition in which calcaneus has elongated process on lateral view
 Putter sign – T-N coalition in which neck of talus unites with broad expansion of
navicular

41
Q

The anterior facet is best seen by which radiographic views?

A

med oblique, ischerwood

42
Q

The middle and posterior facets are best seen by which radiographic view?

A

harris beath

43
Q

what are tx for symptomatic tarsal coalitions

A
Orthotics or supportive therapy
 Immobilization
 NSAIDs
 Badgley – surgical resection of coalition or bar with interposition of muscle belly
 Isolated fusion or triple arthrodesis
44
Q

What are the 3 components of clubfoot?

A

FF add, RF varus, ankle equinus

45
Q

clubfoot what ligaments contracted?

A
Posterior
 Posterior tib-fib
 Posterior talo-fib
 Lateral calcaneofibular
 Syndesmosis
Medial
 Superficial deltoid
 Tibionavicular
 Calcaneonavicular
 Talo-Navic, Navic-Cunei, and Cunei-1st MT joints
 Spring ligament
46
Q

clubfoot What muscles/tendons are contracted?

A
Posterior
 Achilles tendon
 Plantaris tendon
Medially
 PT, FDL, and FHL
 Abductor hallucis
Anteriorly
 Tibialis anterior
47
Q

what is technique for correcting clubfoot called

A

Ponseti technique
 Serial casting
 First correct the FF and RF deformities, and then correct ankle equinus
 During manipulation, pressure is applied to the head of the talus (not the calcaneus)
 4-8 casts, percutaneous Achilles tenotomy (last cast for 3 weeks), occasional TA transfer,
and D-B bar brace until age 3 y/o to prevent relapse

48
Q

accepted theory about clubfoot

A

Germ plasma defect-malposition of head/neck of talus

49
Q

simon rule of 15

A

For clubfoot, children <3 years → talo-navicular subluxation

T-C angle is <15° and talo-1st metatarsal angle is >15°